Davis v. Johns Hopkins Hosp., 288
| Decision Date | 13 February 1991 |
| Docket Number | No. 288,288 |
| Citation | 86 Md.App. 134,585 A.2d 841 |
| Parties | James Robert DAVIS, III, et al. v. JOHNS HOPKINS HOSPITAL. Sept. Term 1990. |
| Court | Court of Special Appeals of Maryland |
Joseph G. Finnerty, Jr. (Jonathan D. Smith, Glen K. Allen and Piper & Marbury, on the brief), Baltimore, for appellee.
Argued before MOYLAN, BISHOP and JAMES S. GETTY (Retired, Specially Assigned), JJ.
James Robert Davis, III (Bobby), by and through his mother and next friend, Deborah Davis, and James Robert
Davis, Jr. and Deborah Davis, individually, appellants, appeal from the adverse ruling of the Circuit Court for Baltimore City granting the Motion for Judgment of appellee Johns Hopkins Hospital (Hopkins).
This case presents the issues of whether there was sufficient evidence:
(1) to support appellants' claim of negligence to require submission of the issue to the jury;
(2) to support appellants' claim of abandonment to require submission of the issue to the jury;
(3) to support appellants' claim of breach of contract to require submission of the issue to the jury; and
(4) to support appellants' claim that appellee failed to conform to the statutory requirements in producing requested medical records to require submission of the issue to the jury.
Within the medical malpractice context, we will discuss two issues, for which there is little law in Maryland: first, the duty of a hospital to accept a patient, second, the abandonment of a patient by a hospital. Also, we will address the issue of the duty of a hospital or related institution to disclose medical records under Md. Health-General Code Ann. § 4-302(d)(2) (1990). 1
Appellants initiated this case by filing a complaint with the Health Claims Arbitration Office. Md.Cts. & Jud.Proc.Code In accordance with Md.Cts. & Jud.Proc.Code Ann. § 3-2A-06 (1989), appellants filed an Action to Nullify Award and a Complaint in the Circuit Court for Baltimore City. This complaint was the same as the complaint filed with the Health Claims Arbitration Office. Four months later, appellants filed an amended complaint and election for jury trial. The amended complaint incorporated by reference the three counts of the original complaint and added four more. Count IV alleged that appellee refused to provide appellants copies of Bobby's medical records in violation of Md. Health-General Code Ann. § 4-302 (1990) resulting in additional expense, pain and suffering. Count V alleged abandonment of Bobby and claimed that appellee refused to provide care to Bobby as agreed. Count VI, which alleged breach of contract, claimed that appellee initially refused to treat Bobby as "promised, contracted and agreed." Count VII alleged that appellee maliciously interfered with the Davises' efforts to obtain medical care for Bobby elsewhere.
Ann. § 3-2A-04 (1989). The complaint contained three counts, all alleging that appellee negligently delayed in admitting Bobby to Hopkins causing Bobby to suffer severe brain [585 A.2d 843] damage. Count I sought damages for Bobby's pain and suffering; Count II was for the medical expenses, past and future, and an award to his parents for their loss of Bobby's companionship; and Count III was for the disruption of the Davises' familial and marital relationships. The case was arbitrated and the panel ruled in favor of Hopkins
The trial court granted appellee's Motion for Summary Judgment on Counts III (disruption of familial and marital relationship) and VII (malicious interference with care), and partial summary judgment on Count II (medical expenses and loss of companionship of parents due to negligence) by limiting recovery to medical expenses. The court also granted appellee's Motion for Bifurcation of the liability and damages issues. Appellants have not complained of these rulings and they are not before us. Md.Rule 8-504; Jacober The remaining counts went to trial before a jury. After argument on Hopkins' Motion for Judgment, the court granted judgment on Count IV (medical records) but denied judgment on the remaining counts. At the close of all the evidence, the court granted judgment in favor of Hopkins on the remaining counts: I (pain and suffering of Bobby due to negligence), II (medical expenses of Bobby due to negligence), V (abandonment) and VI (breach of contract).
v. High Hill Realty, Inc., 22 Md.App. 115, 321 A.2d 838 (1974).
Bobby was born on December 12, 1979. At about eight months old, Hopkins diagnosed that Bobby suffered from status epilepticus, a disorder in which the victim sustains a series of prolonged seizures accompanied by difficulty in breathing. If not treated properly, a seizure could result in brain damage or death due to lack of oxygen. Bobby also suffered from status asthmaticus (long, unremitting asthma attacks) and cerebral palsy. Bobby was a patient of Hopkins since these conditions were first diagnosed.
Because Bobby lived with his family in Anne Arundel County, whenever Bobby would have an attack, emergency medical assistance was provided initially by paramedics of the Anne Arundel Fire Department (AAFD). AAFD protocol required that a patient in a seizure and in need of hospitalization would be taken to the nearest hospital which, in Bobby's case, was North Arundel County Hospital (NACH). On one occasion, while receiving emergency treatment for a seizure, Bobby went into respiratory arrest at NACH. On another occasion, treatment was delayed because a staff member at NACH was unfamiliar with one of Bobby's medications. Concerned that Bobby's condition was too complex for the NACH staff, Mr. Davis sought to have Bobby transported directly to Hopkins for treatment of future seizures. In order to deviate from its protocol, AAFD officials told Mr. Davis that a letter was required After Mr. Davis conferred with Dr. Shlomo Shinnar, one of Bobby's neurologists at Hopkins, the following letter was prepared on the Hopkins' letterhead, signed by Dr. Shinnar and his superior, Dr. John M. Freeman:
from Hopkins stating that it was medically acceptable to transport Bobby directly to Hopkins.
I am writing to you concerning special transportation arrangements for James Davis. James is a one year old child with a complex seizure disorder who is followed by us at the Pediatric Neurology clinic at Johns Hopkins. He is currently on multiple medications including phenobarbital, clonazepam and valproate. When James goes into status epilepticus, which he does frequently with high fevers, he is difficult to manage. In the past he has required transfer to the Johns Hopkins Pediatric Intensive Care Unit or the Pediatric Neurology ward each time. Initial management at the outlying hospital was at times delayed secondary to lack of familiarity with James' complex seizure disorder. I feel that in view of these problems it would be better to transport James directly to the Johns Hopkins Pediatric Emergency Room with advance warning by radio to the ER and pediatric neurology. There are always risks in transporting a seizing child, but I feel that they are in this case justified. These risks have been explained to James' parents who understand and support this decision. I will be glad to provide more details on request.
Sincerely
Shlomo Shinnar, M.D., Ph.D
Department of Pediatric
Neurology
John M. Freeman, M.D
Director
Pediatric Neurology
Department
In the event Bobby could not be treated at Hopkins, Dr. Shinnar and other Hopkins physicians provided the Davises with "To Whom It May Concern" letters that listed the dosages of his current medication, the medication necessary to stop his seizures and other instructions on how to manage his condition. As Bobby's condition and thus his treatment changed, the letters were updated. Seven letters were drafted and delivered to the Davises. The Davises always carried a copy of the latest letter with them. In August 1982, Bobby was taken to the Medical College of Virginia Hospital because he began seizing while at Kings Dominion, an amusement park nearby. Through the use of the latest letter the paramedics and the doctor at the hospital properly treated Bobby.
Based on the receipt of the February 9, 1981 letter, Chief Simonds of the AAFD directed the paramedic units to transport Bobby directly to Hopkins. As a result, from February 9, 1981, until July 1982, Bobby was transported to Hopkins nine times by ambulance and twice by helicopter. Hopkins never designated which method of transportation was preferable. In July 1982, the AAFD decided always to transport Bobby by helicopter, weather permitting. An AAFD mobile paramedic unit would take Bobby to a rendezvous point where a waiting helicopter would transport him to Hopkins. Between July 1982 and March 2, 1983, Bobby was transported to Hopkins eight times by helicopter and once by ambulance because of fog. By ambulance, the trip from the Davis' home to Hopkins took approximately thirty five minutes. By helicopter, the same trip took approximately twelve minutes plus a few minutes for the time to Bobby's mode of transportation determined the unit at Hopkins to which he was delivered. When brought by ambulance, he arrived at the Pediatric Emergency Room located on the first floor. When brought by helicopter, he was landed on the roof of the Children's Center (14th floor) and then taken to the Pediatric Intensive Care Unit (PICU) located on the 7th floor.
travel by ambulance from the Davis' home to the rendezvous point.
The PICU at Hopkins is part of the Maryland Institute...
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