Attorney General v. Johnson

Citation385 A.2d 57,282 Md. 274
Decision Date05 April 1978
Docket NumberNo. 108,108
PartiesATTORNEY GENERAL of Maryland et al. v. James JOHNSON et al.
CourtCourt of Appeals of Maryland

Angus R. Everton, Stephen J. Sfekas, Asst. Atty. Gen., and John F. King, Baltimore (Anderson, Coe & King, Baltimore, on the brief), for appellants.

Marvin Ellin and Jonathan Schochor, Baltimore (Ellin & Baker, Baltimore, on the brief), for James Johnson.

James L. Thompson, Rockville (Arthur S. Feld, Robert R. Michael, Gaithersburg, Alan S. Feld, Bethesda, and Virginia R. Huebner, Rockville, on the brief), for Bar Association of Montgomery County, Maryland.


DIGGES, Judge.

In 1976 the Maryland General Assembly passed legislation, as have many other state legislatures, substantially altering the manner in which claims of medical malpractice by patients against physicians, hospitals, and other "health care providers" may be judicially resolved. 1 In general terms, the effect of this State's Health Care Malpractice Claims statute, Md.Code (1974, 1977 Cum.Supp.), §§ 3-2A01 to 3-2A09 of the Courts Article (the Act), is to require the submission of certain of such claims to an arbitration panel for initial ascertainment of liability and damages before resort may be had to a court of law for final determination. The plaintiffs in this declaratory judgment action asserted that the Act is constitutionally infirm as impermissibly vesting judicial power in a nonjudicial body in violation of separation of powers principles, as abridging the rights of access to the courts and of trial by jury, and as denying to malpractice claimants the equal protection of the laws. Our careful assessment of these assertions reveals that the statute is in each respect constitutionally sound.

The suit arose when James and Sheila Johnson, claiming that their minor daughter had died as a result of the negligence of unnamed physicians employed by The Johns Hopkins Hospital, and distressed by the fact that they were prevented by the 1976 enactment from immediately instituting a malpractice action in a court of law, sought a declaratory judgment to the effect that the Act violated federal and state constitutional provisions and that they should therefore be permitted to file their law suit without first complying with the new statute. Originally named as defendants were Francis B. Burch, Attorney General of the State of Maryland, and Ronald Schreiber, Deputy Legislative Officer for the Governor and Acting Director of the Health Claims Arbitration Office created by the statute. The Johnsons amended their petition to include The Johns Hopkins Hospital as a party defendant, and the trial court permitted intervention as parties defendant by the Medical Mutual Liability Insurance Society of Maryland, a physician-controlled insurance company created by statute, and the Medical and Chirurgical Faculty of the State of Maryland, a voluntary professional organization of Maryland physicians; the Bar Association of Montgomery County was also permitted to intervene as a party plaintiff. 2

With the forces thus arrayed for battle, trial was had in the Baltimore City Court during the period April 25 to May 6, 1977; on June 6 judgment was entered declaring the Act invalid, the court holding that the statute unconstitutionally vested judicial power in an administrative agency and that it imposed procedural and monetary impediments substantial enough to deny claimants reasonable access to the courts and the attendant right to trial by jury. The defendants noted a timely appeal, and the plaintiffs cross-appealed from the trial court's holding that the Act did not violate the equal protection clause of the United States Constitution or the corollary due process requirements of the Maryland Declaration of Rights. We granted certiorari prior to consideration of the matter by the Court of Special Appeals and now reverse the judgment entered in the Baltimore City Court.

We have already noted the general thrust of the Act that medical malpractice claims be submitted to arbitration as a precondition to court action and we now outline in greater detail the mode envisioned by the statute for the accomplishment of the arbitration process and any subsequent court litigation. All malpractice claims against health care providers 3 seeking damages of more than $5,000 are subject to the provisions of the Act, § 3-2A02(a), and must be initially filed, as must the responses to them, with the Health Claims Arbitration Office, § 3-2A04(a), created by the statute "as a unit in the Executive Department." § 3-2A03(a). The office, acting through its director, see § 3-2A03(a), refers all issues raised to a three-member arbitration panel, § 3-2A05(a), chosen at random from lists of qualified persons prepared and maintained by the director, §§ 3-2A03(c) & 3-2A04(b); the panel for each claim is to be composed of an attorney, a health care provider, and a member of the general public. 4 §§ 3-2A03(c) & 3-2A04(d). The arbitration panel determines whether the health care provider is liable to the claimant and if so the extent of the damages, and incorporates in its award an assessment of costs, including arbitrators' fees, § 3-2A05(d) & (e); if no party rejects the award, it becomes final and binding, is filed by the director with the appropriate circuit court, and when confirmed by that court constitutes a final judgment. § 3-2A05(h). 5 Neither party, however, is in any way bound to accept the award; it may be rejected for any reason within ninety days. § 3-2A06(a). If a party desires to contest the decision of the panel, he must file an action in the appropriate court during the ninety-day period to nullify the award, § 3-2A06(b) & (f), 6 and jury trial may be elected by either party. § 3-2A06(b). Any contention that an award should be vacated on the ground of corruption, fraud, partiality or the like, see Md.Code (1974), § 3-224(b)(1)-(4) of the Courts Article, is to be decided by the court prior to trial. § 3-2A06(c). Unless the award is thus vacated, it is admissible as evidence at the trial and presumed to be correct, with the burden of proving the contrary falling on the party rejecting it, § 3-2A06(d); should the award be vacated, "trial of the case shall proceed as if there had been no award." § 3-2A06(c). In addition, attorneys' fees are subjected to the approval respectively of the arbitration panel and the court. § 3-2A07.

Before beginning our analysis of the several challenges to the statute, we refer briefly to the circumstances, as developed at trial, which spurred the passage of this legislation. The appellees sought to show that the malpractice insurance "crisis" sweeping the nation, see note one supra, had avoided the State of Maryland, and that the General Assembly had imposed a draconian solution to a minor problem; as they put it, surgery has been performed when the patient could have been cured with aspirin. It is clear that although the dominant insurer in Maryland received a dramatic rate increase in 1974, it nonetheless decided to cease writing medical malpractice insurance in this State when it was refused its request for an additional substantial increase later that year. 7 The General Assembly at its 1975 session responded to this withdrawal notice by creating, effective in June of that year, the Medical Mutual Liability Insurance Society of Maryland, see Md.Code (1957, 1972 Repl.Vol., 1977 Cum.Supp.), Art. 48A, §§ 548-556, an insurance company initially funded by a tax on Maryland physicians, and which now insures ninety percent of the State's doctors; availability of coverage was thereby assured. 8 In July of that year, the presiding officers of both houses of the General Assembly jointly appointed a Medical Malpractice Insurance Study Committee, which in its subsequent report to the legislature indicated that the creation of Medical Mutual represented only temporary relief for the "myriad problems of medical malpractice insurance," and recommended legislation similar to the present Act.

At trial the appellees attempted to show that the appellant Medical and Chirurgical Faculty, upon the withdrawal of the dominant insurer, frustrated new carriers from entering the market and thus itself precipitated the crisis; the trial court, however, rejected this suggestion as not being factually supported by the evidence. A great deal of testimony was also adduced during the course of the trial respecting the cost of prosecuting malpractice claims and the effect on those costs of the newly-created arbitration proceedings, the trial court concluding that a claimant's costs would be substantially increased if the case were brought to court after arbitration, and reduced if the arbitration award were accepted.

With this background, and bearing in mind that before a statute may be declared unconstitutional "its repugnancy to the provisions or necessary implications of the Constitution should be manifest and free from all reasonable doubt," Baltimore v. State, 15 Md. 376, 475 (1860) (concurring opinion); see Lucky Stores v. Bd. of Appeals, 270 Md. 513, 526, 312 A.2d 758, 765 (1973), we pause before addressing the particular constitutional issues to point out two basic tenets which are helpful to recall in an analysis of a statute of the character here presented. The first was well stated by Judge O'Donnell for this Court in Salisbury Beauty Schools v. St. Bd., 268 Md. 32, 48-49, 300 A.2d 367, 378 (1973):

The wisdom or expediency of a law adopted in the exercise of the police power of the state is not subject to judicial review and such a statute will not be held void if there are any considerations relating to the public welfare by which it can be supported. Such a statute is presumed to be valid and one attacking its validity has the burden of affirmatively and clearly establishing its invalidity; every intendment is in favor of...

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