Lead Opinion
announcing the judgment of the Court, in an opinion in which RODOWSKY and McAULIFFE, JJ., join; ELDRIDGE, J., concurs in the judgment in an opinion in which COLE and CHASANOW, JJ., join.
This case concerns punitive damages in a medical malpractice action. It focuses on our holding in H & R Block Inc. v. Testerman,
I.
It is well settled law in Maryland, and the general rule elsewhere, that punitive damages are prohibited in a pure action for breach of contract. Miller Building Supply v. Rosen,
“In a tort case where punitive damages are permitted, in order to obtain such an award a plaintiff must prove actual malice or its legal equivalent.” Siegman v. Equitable Trust Co., supra,
Implied or legal malice “may be defined as conduct of an extraordinary nature characterized by a wanton or reckless disregard for the rights of others.” Wedeman v. City Chevrolet Co.,
As we stated in Testerman, the landmark case regarding punitive damages in actions arising out of contractual relationships is Knickerbocker Co. v. Gardiner Co.,
In light of Knickerbocker and its progeny there appear to be only two cases in which punitive damages have been permitted for torts arising out of contracts: Rinaldi v. Tana, 252 Md. 544,
In Testerman, the plaintiffs claimed negligent preparation of their tax returns. We held that “where the tort is one arising out of a contractual relationship, actual malice is a prerequisite to the recovery of punitive damages.”
II.
In 1973, Amelia R. Schaefer began seeing Gerald A. Miller, M.D., a board certified ophthalmologist, for annual eye examinations. In 1982, when Schaefer was 72 years
At her next annual eye examination, in July 1983, Miller advised Schaefer that the cataract was ready to be removed. Viewing the evidence in a light most favorable to Schaefer, Miller advised her that the cataract needed to be removed but he did not perform an examination of her eye at that time and did not test her vision. Miller, on the other hand, claimed to have performed an acuity test, a binocularity test, and a glaucoma test.
Schaefer agreed to have Miller perform a cataract operation at St. Agnes Hospital on an outpatient basis. Thereafter Miller removed the cataract and implanted an intraocular lens in Schaefer’s eye.
A few days after the surgery, Schaefer complained of pain in her eye. Miller determined that her eye was infected, and admitted her to the hospital. She was treated with antibiotics and Miller scheduled her for a vitrectomy (removal of pus from the eye). The vitrectomy revealed a significant amount of purulent material in Schaefer’s eye. Schaefer remained in the hospital for two weeks, during which time she was on antibiotics, suffered pain, and was unable to see out of the affected eye.
During a subsequent office visit, on August 24, 1983, Miller again determined that Schaefer’s eye was infected. On that occasion and two subsequent office visits, Miller treated Schaefer’s eye \yith laser therapy to open a membrane that was blocking her vision. After the last treatment, he told her that she had 20/40 vision in her eye. Schaefer visited Miller’s office one more time, when she
Schaefer filed a medical malpractice claim against Miller, on October 1, 1984. A unanimous Health Claims Arbitration panel awarded Schaefer $1.00 in compensatory damages and $25,000 in punitive damages. Both parties rejected the award. Thereafter, Schaefer filed a complaint against Miller in the Circuit Court for Baltimore City. It contained two counts: (1) that Miller performed the surgery on Schaefer without informed consent and (2) that Miller failed to comport with the applicable standards of care in Schaefer’s preoperative and postoperative treatment.
Before a jury, Dr. Gleicher testified that Miller failed to comply with the required standards of care for obtaining informed consent and treating Schaefer’s post-operative infection which caused her chronic pain, retinal degeneration, decreased visual acuity and light sensitivity.
Schaefer testified that Miller did not describe the surgical procedure involved in cataract removal or the accompanying risks. Her only knowledge of cataract removal came from a portion of a television program which she had seen about two months prior to the examination. She said that she was only willing to have her cataract removed and was unaware of anything about an intraocular lens implant.
Called as an adverse witness by Schaefer, Miller produced an informed consent form purportedly signed by Schaefer for the cataract removal and the intraocular lens implantation. Schaefer disputed that she had signed the document and adduced evidence that on a previous occasion in 1978, Miller forged a patient’s signature on an informed consent form for an intraocular lens implant. Subsequently, Miller admitted at the trial to having committed this act, and to rewriting some other records. He acknowledged that he was sanctioned in 1985 by the Commission on Medical Discipline which ordered that his license to practice medi
The evidence showed that the consent form, which Miller claimed Schaefer signed, was signed by Miller in both the doctor and witness signature blanks. The time and place blanks were not completed. The consent form was not part of the St. Agnes Hospital records, but was produced by Miller when Schaefer requested her medical records.
The trial judge instructed the jury on the applicable standards for determining negligence vel non. He said:
“This case then is simply a claim of negligence by a patient against her doctor and as I indicated to you at the outset of the trial, the words medical malpractice should be of no concern to you and is simply a term often used to describe a negligence action against a health care provider. What we are concerned about is simply whether or not the defendant was negligent in any way with respect to the plaintiff.”
The court also instructed the jury that it could award Schaefer punitive damages upon a finding that Miller acted with implied malice. It gave the following instruction:
“Punitive damages may only be awarded if you find that the defendant was not merely negligent, but acted with malice. That is, he acted so recklessly or outrageously as to indicate a wanton disregard for the rights, health or safety of the plaintiff or with a callous indifference to the consequences.”
On June 16, 1988 the jury returned a verdict of $350,000 in compensatory damages and $750,000 in punitive damages. Schaefer consented to a remittitur of the compensatory damages from $350,000 to $50,000. On August 5,1988 judgment was entered against Miller for $50,000 in compensatory damages and $750,000 in punitive damages.
Miller appealed to the Court of Special Appeals. He argued that the judgment for punitive damages should be
III.
In the Court of Special Appeals, Schaefer argued that Miller committed three distinct torts: fraud, battery and negligence. As to fraud, Schaefer contended that Miller fraudulently induced her to undergo the surgery when it was not necessary and, because the representation was false, no contractual relationship was created. As to the battery, Schaefer argued that by implanting an intraocular lens without any consent, Miller committed a battery upon her.
In its opinion, the intermediate appellate court pointed out that Schaefer’s complaint did not contain any allegations of fraud or battery and that her action was based solely upon two theories of negligence, namely, that Miller performed the surgery without informed consent and that Miller failed to comport with the applicable standards of care in Schaefer’s preoperative and postoperative treatment.
The Court of Special Appeals noted that the relationship between physician and patient is a consensual one arising out of an express or implied contract. Id. It reviewed the relevant authority regarding the relationship between physicians and patients and the nature of malpractice suits. Citing a number of Maryland cases, and analogizing medical and legal professional malpractice suits, the court determined that before a physician may be found liable for an act of medical/malpractice, it is essential that a patient-physician relationship be in existence at the time the alleged act occurred. Id. The court relied in part upon Hoover v. Williamson,
“that ordinarily recovery for malpractice or negligence against a doctor is allowed only where there is a relationship of doctor and patient as a result of a contract, express or implied, that the doctor will treat the patient with professional skill and the patient will pay for such treatment, and there has been a breach of professional*307 duty to the patient.”3
The court concluded that a contractual relationship arose in this case when Schaefer accepted Miller’s diagnosis that the cataract in her right eye had to be removed. Id.,
The court considered but found no merit in Schaefer’s contention that because her consent was not informed as to the particular type of cataract operation performed, there was no contract out of which the tort arose and thus the Testerman punitive damage rule did not apply. Citing Sard v. Hardy,
IV.
In her certiorari petition, Schaefer claimed that
“[t]he essence of plaintiff’s case at trial was that 1) the defendant either negligently or fraudulently failed to obtain the plaintiff’s informed consent in violation of fiduciary duties, 2) the defendant either negligently or fraudulently induced the plaintiff to have cataract surgery when it was not needed in violation of his fiduciary duties, 3) the defendant performed an intraocular lens implant without obtaining any consent, much less informed consent, also in violation of his fiduciary duties, and 4) the defendant was negligent in failing to recognize the plaintiff’s postoperative infection earlier, failed to treat it immediately, performed a vitrectomy when it should have been performed by an expert and negligently performed laser treatments on the plaintiff’s eye.”
Upon this foundation, Schaefer presented two questions in her certiorari petition:
1. Whether the verdict for punitive damages should be reinstated because the torts in this case did not arise out of a contractual relationship and therefore punitive damages may properly be obtained on a showing of implied malice.
2. Whether implied malice is the proper standard in a contract action involving a breach of fiduciary duty.
In opposing Schaefer’s petition, Miller protested that the torts of battery and fraud were never asserted at the trial. He said that “[t]here was never even a claim, let alone an issue of fraudulent inducement or battery”; rather, the
V.
Before us, Schaefer argues that Testerman and its progeny establish artificial distinctions between actual ana implied malice that complicate the objectives of punitive damages. While she does not argue for a direct overruling of Testerman, she urges that we create an exception to the Testerman rule, establishing implied rather than actual malice as the standard for the recovery of punitive damages in contract actions involving a breach of fiduciary duty. Schaefer further asserts that there was fraud in the inducement of the contract in this case, which breached the doctor-patient fiduciary relationship and thus voided the contractual relationship. She claims that it was not necessary that she specially pled fraud and battery to recover punitive damages because Miller, through his wanton and egregious behavior, overstepped the line which divides negligence from fraud in a medical malpractice case. In this regard, she says that the allegations of her complaint are not essentially contractual in nature, but rather relate to tortious conduct evidencing a breach of fiduciary duty, and thus implied malice is the approved standard for an award of punitive damages. During oral argument, Schaefer candidly admitted that she consciously declined to allege breach of a fiduciary duty as a separate count for several reasons, one of which was to avoid the risk of denial of insurance coverage under Miller’s malpractice policy.
We agree with the Court of Special Appeals that a contractual relationship existed between Miller and Schae
On the record before us, we conclude that the negligence in this case arose out of a contractual relationship which preexisted the tortious conduct; and that the negligence “found its source in the contract without which the wrong would not have been committed.” See Wedeman v. City Chevrolet Co., supra,
It may be, as Chief Judge Gilbert said in his concurring opinion in this case,
“Recognizing that torts arising out of contractual relationships exhibit characteristics of both tort and contract actions, we sought in Testerman to fashion a workable rule governing the recovery of punitive damages which would be more stringent than that applied in pure tort cases, but which at the same time would allow the possibility of recovery where the particular conduct clearly warranted the imposition of such damages.”
Finally, we allude again to Miller Building Supply v. Rosen, supra, a case in which an employer sued two of its former salesmen for fraud, civil conspiracy, and breach of fiduciary duty. There, the employer’s claims arose from the employment contracts between the employer and its former employees.
We thus conclude that the award of punitive damages in this case was contrary to our holding in Testerman and was therefore properly reversed.
JUDGMENT AFFIRMED, WITH COSTS.
RODOWSKY and McAULIFFE, JJ., concur.
ELDRIDGE, J., concurs in the judgment with an opinion in which CHASANOW, J., and COLE, J. (Retired) join.
Notes
. In his brief, Miller asserts that intraocular lens implants are a standard technique in treating cataracts, and that they were “used in 90% of the cases at the time of [Schaefer's] operation, and in 95-98% of the cases at the time of trial.”
. The issues as framed on the special verdict sheet were as follows:
“1. Did the defendant comply with the standards of care applicable to him in making an adequate disclosure of material facts to the plaintiff relative to the treatment which she underwent, and did she knowingly and intelligently agree to this procedure being done?
"2. Did the defendant comply with the standards of care applicable to him in all of his pre-operative procedures and post operative care with respect to the plaintiff?
*306 "3. If your answer to issue 1 or 2 is ‘no’, do you find that any such breach of standard of care by the defendant was the proximate cause of any injury, loss or damage to the plaintiff?
“4. If your answer to issue 3 is ‘yes’, in what amount do you award compensatory damages to the plaintiff?
"5. If you have awarded compensatory damages to the plaintiff, you may but are not required to award to the plaintiff punitive damages as well. Punitive damages may only be awarded if you find that the defendant was not merely negligent but acted with malice, that is he acted so recklessly or outrageously as to indicate a wanton disregard for the rights, health or safety of the plaintiff, or a callous indifference to the consequences. If you do award punitive damages, in what amount do you award them?”
. In Hoover, we recognized that a physician may incur a tort obligation under nonconsensual circumstances and independent of contract if he “assumes to act, even though gratuitously.”
Concurrence Opinion
concurring:
I concur in the result reached in this case; however, I do not concur in Chief Judge Murphy’s opinion announcing the judgment. Specifically, I disagree with Chief Judge Murphy’s adherence to the Testerman-Wedeman standard governing awards of punitive damages in tort cases where actual malice is not proven. The standard, which originated in H & R Block, Inc. v. Testerman, 275 Md. 36,
The Testerman-Wedeman rule was not supported by the Maryland cases relied upon in the Testerman and Wedeman opinions and is not supported by the decisions in any other jurisdiction. The rule has utterly no relationship to the purposes of punitive damages, leads to irrational results, and has been arbitrarily and inconsistently applied.
With respect to the allowance of punitive damages in tort actions grounded upon negligence, I would return to one of the two rules which had prevailed in Maryland before the adoption of the Testerman-Wedeman standard in 1975-1976. Prior to 1972, in the absence of statute, punitive damages were not recoverable in negligence actions unless there was actual malice or similar wrongful motive. Davis v. Gordon,
In the case at bar, the plaintiff is not entitled to punitive damages under either the standard of Smith v. Gray Concrete Pipe Co., supra, or the pre-Smith rule.
I.
A.
H & R Block, Inc. v. Testerman, supra, was inter alia, a tort action based upon the defendant’s negligence in connection with the preparation of the plaintiffs’ income tax returns. The plaintiffs sought both compensatory and punitive damages, but the trial court dismissed the claim for punitive damages. The trial court seemed to indicate that, in a negligence action, punitive damages were recoverable where there was implied malice consisting of “extraordinary or outrageous behavior ... or wanton conduct,” but the court held that the defendant’s actions, although negligent, did not meet this standard.
This Court in Testerman reversed the decision of the Court of Special Appeals. The Court’s opinion agreed with the Court of Special Appeals that the gist of the tortious conduct was that “Block was demonstrably negligent in hiring inexperienced employees, and in holding them out to the public as qualified consultants____” H & R Block, Inc. v. Testerman, supra,
“arose out of a contractual relationship. Consequently, actual malice is a prerequisite to the recovery of punitive damages in this case.
“Plainly, there was no actual malice here.”275 Md. at 47 ,338 A.2d at 54 .
The Testerman opinion did not indicate what would be the standard for determining implied malice in a tort action not arising out of a contractual relationship.
The following year, in Wedeman v. City Chevrolet, supra,
The plaintiff in Wedeman recovered both compensatory and punitive damages from the dealer, but the Court of Special Appeals reversed the award of punitive damages in light of Testerman. The intermediate appellate court reviewed the facts of Testerman, indicated that the tortious conduct of the automobile dealer similarly arose out of a contractual relationship, and that, therefore, punitive damages were not recoverable based on implied malice. City Chevrolet v. Wedeman,
This Court in Wedeman reversed the judgment of the Court of Special Appeals and reinstated the award of punitive damages, holding that the tort did not arise out of a contractual relationship and that, therefore, punitive damages could be based on implied malice. This Court held that a tort arises out of a contractual relationship within the meaning of Testerman only when “the contractual relationship preexisted the tortious conduct____ Thus, when one may be induced by fraud to enter into a contract, the tort in
B.
The “arising out of contractual relations” rule formulated in Testerman and Wedeman had no support in the Maryland cases relied on in the Testerman and Wedeman opinions.
As previously mentioned, the principal case relied upon in Testerman was Knickerbocker Co. v. Gardiner Co., supra,
The disallowance of punitive damages based on implied malice in tort actions for interference with economic relations has utterly nothing to do with whether the wrongful conduct preceded or followed a contract. Instead, the disallowance is grounded in the nature of the tort itself. Although interference with contractual or economic relationships is an intentional tort requiring wrongful conduct, actual malice in the sense of ill will towards the defendant is not a necessary ingredient.
C.
In addition to the lack of support in the cases relied on in the Testerman opinion, the Testerman-Wedeman rule was inconsistent with several previous decisions of this Court.
On the other hand, there are many Maryland cases where there was no contractual relationship between the parties but where, because of the particular type of tort involved, the Court held that actual malice was required for an award of punitive damages. See, e.g., Davis v. Gordon, supra,
Therefore, under Maryland tort cases from the earliest days until recently, the allowability of punitive damages
D.
Moreover, the Testerman-Wedeman rule has no relation whatever to the purposes of punitive damages. This Court has pointed out that there are dual purposes in awarding punitive damages, namely “ ‘as punishment for outrageous conduct and to deter future transgressions.’ ” Nast v. Lockett,
The Testerman-Wedeman rule, however, instead of relating to the heinousness of the defendant’s conduct, is tied to when that conduct occurs relative to a contract between the parties. Under the Testerman-Wedeman standard, in the absence of actual malice, if there is a contract between
Since the Testerman-Wedeman rule has no relation to the conduct which punitive damages are intended to punish or deter, application of the rule can lead to completely irrational results. For example, to vary the facts in the Wedeman case, let us assume that the automobile had not been damaged in shipment to the dealer but had been damaged to the same extent, and then repaired by the dealer, between the time the contract of sale was signed and the time of delivery. Furthermore, assume that, at the time of delivery, in response to the plaintiff’s question, and to induce the plaintiff to accept delivery, the salesman had reiterated to the plaintiff that the car had “never been ... damaged in any way.” Under this scenario, because the fraudulent conduct would have occurred after the contract, the result in the case would have been different from the result in Wedeman, and punitive damages would not have been allowed.
E.
Finally, the Testerman-Wedeman rule has been arbitrarily and inconsistently applied by this Court. The initial
This Court’s Wedeman opinion, however, totally ignored the facts in Testerman on which the punitive damage claim was based. We simply included Testerman with a string of citations to cases involving breach of contract and tortious interference with contract, and erroneously stated that “[tjhose cases ... had in common one salient fact: the contractual relationship preexisted the tortious conduct.” Wedeman v. City Chevrolet Co., supra,
Another instance of the arbitrary and inconsistent application of the Testerman-Wedeman rule is General Motors Corp. v. Piskor,
The Court in Piskor then held that the defendant’s conduct did not arise out of the contractual relationship. The
It is difficult to understand why the critical tortious conduct in Testerman had a greater nexus with a contract than the tortious conduct in Piskor. If an employee, while on the job, is stealing his employer’s property, it would seem to constitute a breach of his obligations under the employment contract. An employer’s attempt to determine whether an employee was stealing company property while at work would appear to be directly related to the employment contract. As to the second reason in Piskor for distinguishing Testerman, the determination of which torts are “pure” seems to present insurmountable problems. The opinion does not define “pure.”
The plaintiff in Henderson brought an action for conversion, recovering both compensatory and punitive damages. The Court of Special Appeals reversed the award of punitive damages on the ground that there was no evidence of actual malice and that, under Testerman, punitive damages could not be recovered based on implied malice. This Court, however, reinstated the award of punitive damages, holding that the evidence of the bank’s conduct, particularly the insistence that the plaintiff bring his records to the bank, “permitted a reasonable and probable inference that the bank employee was motivated by actual malice,” Henderson v. Maryland Nat’l Bank, supra,
With regard to punitive damages in tort cases where a contract exists, this Court, beginning with its Testerman opinion, has seemed to create new rules on a case by case basis in order to achieve the result desired in each particular case. These “rules” have little or no foundation in pre-Testerman Maryland law and lead to inconsistent results. I would totally abandon the Testerman-Wedeman standard and return to the principles relating to punitive damages which had prevailed in this State for many, many years before Testerman.
II.
The case before us is a negligence action and should be governed by the principles applicable to such actions. As indicated earlier, prior to 1972, in the absence of statute, punitive damages were not recoverable in negligence actions absent actual malice or similar wrongful motive. They were not recoverable on an implied malice basis no matter how gross, reckless, or wanton the defendant’s conduct might be.
The leading case is Davis v. Gordon, supra,
“We have many rules of the road, all designed and intended to promote the public safety. They have severe penalties for their violation whether there is an accident or not. If all drivers and all pedestrians observed these rules there would not be any accidents. The rules of the road are far more effective than any inflammatory verdicts in making our streets and highways safe for travel. The fear of arrest is more of a deterrent than a verdict in a civil case for damages.”
The 1972 decision in Smith v. Gray Concrete Pipe Co., supra,
The Smith opinion emphasized that the implied malice standard there adopted stops “just short of wilful or intentional injury” and “contemplates conduct which is of an extraordinary or outrageous character.”
It is somewhat unclear whether the Smith holding, concerning the recovery of punitive damages in a negligence action based on implied malice, applies only to actions involving the negligent entrustment and/or operation of
III.
In the present case, either under Davis v. Gordon, supra, or Smith v. Gray Concrete Pipe Co., supra, a reversal of the award for punitive damages would be required. Clearly there was no showing of actual malice in this case. Therefore, under Davis v. Gordon, punitive damages would not be recoverable.
Moreover, there should be no recovery of punitive damages here under the stringent implied malice standard set forth in the Smith case. The plaintiffs proof at trial was insufficient to demonstrate the requisite wanton and reckless conduct to justify punitive damages under the Smith test. The conduct causing plaintiffs injury demonstrates only simple negligence by the defendant. The failure to
The plaintiff’s attorney argued extensively to the jury that an award of punitive damages was justified based on the evidence that Dr. Miller had forged Ms. Schaefer’s signature to the informed consent form and had rewritten some of her medical records. Although this conduct is wanton and outrageous, and would meet the Smith standard in a different context, it occurred subsequent to the injury to Ms. Schaefer and did not cause or contribute to it. Thus, there was no implied malice involved in Dr. Miller’s negligence in failing to obtain informed consent and in his post-operative care. This negligence action is not the proper vehicle for punishing Dr. Miller for his later conduct. Rather, the Commission on Medical Discipline is the appropriate body to address such matters.
IV.
In recent years there has been a proliferation of claims for punitive damages in tort cases, and particularly in negligence cases. Studies have indicated that punitive damage awards have increased greatly in frequency and in amount. See, e.g., M. Peterson, S. Sarma, M. Shanley, Punitive Damages (Rand, The Institute for Civil Justice,
The adoption and application of the Tester-man-Wedeman rule, however, have greatly compounded the problem of routine punitive damage claims and awards in civil actions. In light of the case-by-case inconsistency and confusion inherent in this Court’s opinions on punitive damages over the last twenty years, it is understandable that a lawyer would include a claim for punitive damages in almost any tort case. Perhaps the next shift by this Court, or the next new rule or variation adopted, will benefit the plaintiff in that particular case.
The most appropriate action which this Court could take, with regard to the unwarranted claims for and awards of punitive damages, would be to overrule H & R Block, Inc. v. Testerman, supra, and its progeny.
Judges COLE and CHASANOW have authorized me to state that they concur with the views expressed herein.
. Opinion of the trial court, quoted by the Court of Special Appeals in Testerman v. H & R Block, 22 Md.App. 320, 323-325,
. Some earlier Maryland cases had indicated that the existence of fraud itself showed a sufficiently evil motive to support an award of punitive damages, and that no further showing was required. See, e.g., Phil., Wilm. & Balt. Railroad Co. v. Hoeflich,
. See Daugherty v. Kessler,
. The only case cited in Testerman which contains language apparently supporting the Testerman-Wedeman rule is St. Paul at Chase Corp. v. Manufacturers Life Ins. Co.,
. See, e.g., K & K Management v. Lee,
. See Miller Building Supply v. Rosen,
. Thus we are given no clue as to why assault and false imprisonment are “pure" but fraud, conversion, and negligence are not.
. I am well-aware that I joined all of the opinions of this Court which I criticize today. See, however, McGrath v. Kristensen,
. There was evidence presented at trial that at the time of Ms. Schaefer’s operation, approximately 90-95% of all cataract patients underwent such an operation.
