Martinez v. Johns Hopkins Hosp.

Decision Date03 July 2013
Docket NumberNo. 1394,Sept. Term, 2012.,1394
Citation212 Md.App. 634,70 A.3d 397
PartiesEnzo MARTINEZ, a minor, by and through his parents and next friends, Rebecca FIELDING and Enso Martinez, et al. v. THE JOHNS HOPKINS HOSPITAL.
CourtCourt of Special Appeals of Maryland

OPINION TEXT STARTS HERE

James M. Nichols & Byron L. Warnken (Warnken, LLC, Towson, MD, Gary Wais, Keith D. Forman, Wais, Vogelstein, & Arfaa, Pikesville, MD), on the brief for Appellant.

Donald L. DeVries, Jr. & Derek M. Stikeleather (Janet A. Forero, Meghan H. Yanacek, Goodell, DeVries, Leech & Dann, LLP, Baltimore, MD), on the brief for Appellee.

Panel: EYLER, DEBORAH S., GRAEFF, BERGER, JJ.*

BERGER, J.

This case involves a medical malpractice action filed in the Circuit Court for Baltimore City. Appellant and cross-appellee, Enzo Martinez (Martinez), a minor, by and through his parents,1 alleged that appellee and cross-appellant, The Johns Hopkins Hospital (“the Hospital”), negligently failed to perform a timely Caesarean section, causing Martinez to suffer from cerebral palsy, retardation, and other disorders.

After a two week trial, a jury awarded Martinez $4 million for lost wages, $25 million for future medical expenses, and $26 million for non-economic damages. The court entered judgment in favor of Martinez in the amount of $55 million. Thereafter, the Hospital filed a motion for new trial, to alter or amend judgment, and for remittitur. The trial court denied the Hospital's request for a new trial. The trial court further reduced the jury's award for lost wages from $4 million to $2,621,825, and reduced the jury's $26 million award for non-economic damages to $680,000.2 Martinez filed a notice of appeal on September 18, 2012. The Hospital filed a cross-appeal on September 19, 2012.

Martinez presents one question for review, which we have rephrased as follows:

1. Whether the circuit court erred by reducing the jury's non-economic damages award on the basis that Maryland's cap on non-economic damages is unconstitutional because it violates the separation of powers doctrine under the Maryland Declaration of Rights.

The Hospital presents four questions for review, which we have reordered and rephrased as follows:

1. Whether the circuit court abused its discretion by precluding evidence regarding the standard of care applicable to nurse-midwives, and a midwife's breach of that standard of care while treating Ms. Fielding.

2. Whether the circuit court abused its discretion by admitting evidence that Ms. Fielding was never offered general anesthesia.

3. Whether there was sufficient evidence to support a jury award of $25 million for Martinez's future medical expenses.

4. Whether the circuit court abused its discretion by declining to annuitize the jury award.

For the reasons set forth below, we hold that the circuit court erred in precluding evidence of the nurse-midwife standard of care, and in precluding evidence of a breach of that standard of care by a nurse-midwife while treating Ms. Fielding. Accordingly, we reverse the judgment of the Circuit Court for Baltimore City and remand for further proceedings. For guidance on remand, we shall also address whether the circuit court erred in admitting evidence regarding the offering of general anesthesia.

FACTUAL AND PROCEDURAL BACKGROUND

On March 25, 2010, Ms. Fielding began labor with her first child, Martinez. Ms. Fielding elected to have a natural birth at home, with the assistance of Evelyn Muhlhan, a registered nurse midwife (“Midwife Muhlhan”), and a doula. 3

Ms. Fielding (who was 10 days overdue) was in labor for 14.5 hours during the first stage of labor, and at least five hours more in the second stage of labor.4 The position of the baby was occiput posterior.5 This means that the baby's head was down; however, unlike the usual presentation, he was facing forward instead of inward, toward Ms. Fielding's spine.6 At 12:30 a.m., Midwife Muhlhan attempted to expedite delivery while at Ms. Fielding's home. First, Midwife Muhlhan applied fundal pressure 7 to Ms. Fielding two or three times. Second, Midwife Muhlhan injected Ms. Fielding multiple times with Pitocin, a hormone that increases the strength and frequency of contractions. Third, misjudging the state of her labor, Ms. Muhlhan performed an episiotomy, which is a procedure performed upon immediate delivery in which the perineum is cut in order to enlarge the vaginal opening. Finally, Ms. Muhlhan directed Ms. Fielding to cleanse herself with a probiotic treatment, as an alternative to taking antibiotics, in order to prevent the potentially fatal transmission of Group B streptococcus bacteria (for which Ms. Fielding had tested positive), to the baby during labor and delivery. After providing these treatments, Midwife Muhlhan “decided it was time to go to the hospital.” Midwife Muhlhan sutured the episiotomy and called an ambulance.

Ms. Fielding arrived at the Hospital at 3:30 a.m. on March 26, 2010. Ms. Fielding was an unknown patient to the Hospital. The Hospital's labor and delivery team evaluated Ms. Fielding's status and the best way to deliver her baby. The team also applied a fetal heart rate monitor. The medical records indicate that the descent level of the baby was assessed as +1 station 8 when Ms. Fielding arrived at the Hospital. The baby remained at +1 after they gave Ms. Fielding a chance to push a few times.9

At 3:45 a.m., Dr. Christopher Ennen, the treating physician, and Dr. Sherrine Ibrahim, the attending senior resident physician, determined that Ms. Fielding would be unable to deliver Martinez vaginally. Rather, the Hospital's physicians concluded that an “urgent” Caesarean section was required. 10 The Hospital's physicians determinedthat an “emergency” Caesarean section was not required because the fetal heart rate monitor indicated that the fetus was being adequately oxygenated.11

The Hospital team took Ms. Fielding's medical history and drew blood for laboratory testing. The blood tests were sent to the Hospital's laboratory on a “stat” basis, meaning they were the “highest” priority and should be completed “as quickly as possible.” The Hospital explained at trial that the blood testing was necessary in order to determine whether it would be safe to administer spinal/epidural anesthesia to Ms. Fielding during the Caesarean section procedure. The Hospital also administered IV penicillin to Ms. Fielding to reduce the risk of passing her Group B streptococcus bacteria on to Martinez. Further, the Hospital obtained Ms. Fielding's consent for spinal/epidural anesthesia, administered medications to reduce the strength of Ms. Fielding's contractions, and made other pre-delivery preparations.

Some of the laboratory test results were returned at 3:57 a.m. The tests showed a negative result for syphilis. At 4:14 a.m., the Hospital re-ordered the remaining blood tests, which related to Ms. Fielding's blood type and platelet count.12 The remaining laboratory test results were returned at 4:52 a.m. The Hospital determined that, based upon the test results, it would be safe to use spinal/epidural anesthesia for Ms. Fielding's Caesarean section. The anesthesia was administered and Ms. Fielding was prepared for surgery. At 4:57 a.m., the Hospital transported Ms. Fielding to the operating room. Martinez was delivered at 5:40 a.m., and his condition at birth was poor. He now suffers from cerebral palsy, retardation, and other disorders.

Martinez, by and through his parents, filed a complaint alleging that the Hospital negligently failed to perform a timely Caesarean section. In short, Martinez argued that “had [Martinez] been delivered by 4:15 a.m., as the standard of care required, he would not have suffered any injury.” Further, Martinez argued at trial that the Hospital also “fail[ed] to recognize ominous signs of fetal distress.” Martinezcontended that the Hospital should have converted to an emergency Caesarean section based on the status of Martinez's fetal heart rate monitor. Accordingly, Martinez concluded that the Hospital was also negligent in performing an urgent Caesarean section, rather than an emergency Caesarean section.

The Hospital argued that Midwife Muhlhan was solely responsible for Martinez's injuries, and, therefore, that Martinez's injuries “occurred a number of hours prior to the delivery and prior to the arrival at Johns Hopkins.” Additionally, the Hospital argued that the timing in performing the urgent Caesarean section was medically necessary in order to evaluate the effects of Midwife Muhlhan's treatment on Ms. Fielding. The Hospital posited that the delay in receiving blood tests was due, in part, to Ms. Fielding's lack of cooperation.13 Finally, the Hospital maintained that an emergency Caesarean section was not required because the fetal heart rate monitor indicated that the fetus was being adequately oxygenated.

After a two week trial, a jury awarded Martinez $4 million for lost wages, $25 million for future medical expenses, and $26 million for non-economic damages. The court entered judgment in favor of Martinez in the amount of $55 million. Thereafter, the Hospital filed a motion for new trial, to alter or amend judgment, and for remittitur. After a two day hearing, the trial court denied the Hospital's request for a new trial, and reduced the jury's award for lost wages from $4 million to $2,621,825. The trial court further ruled that the Maryland cap on non-economic damages (“the Cap”) was constitutional, and reduced the jury's $26 million award for non-economic damages to $680,000 in accordance with the Cap. Martinez noted this timely appeal, and the Hospital also noted its timely cross-appeal on the following day. Additional facts relevant to the issues on appeal are summarized below.

A. Motion in Limine

Martinez filed a pre-trial motion in limine seeking to exclude testimony regarding the standard of care applicable to Midwife Muhlhan, and Midwife Muhlhan's alleged breach of that standard of care while treating...

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    ...death actions, the legislature did not "create irrational classifications among the claimants"); Martinez v. The John Hopkins Hospital , 212 Md. App. 634, 656 n.19, 70 A.3d 397 (2013) ("it is well settled that the [c]ap is constitutional. The Court of Appeals has consistently upheld the con......
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    • United States
    • Maryland State Bar Association Pleading Causes of Action in Maryland (MSBA) (2022 Ed.) Chapter 3 Torts
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