Raitt v. Johns Hopkins Hospital, 929

• Decision Date: 19 July 1974
• Docket Number: No. 929,929
• Citation: 322 A.2d 548,22 Md.App. 196
• Parties: Anna M. RAITT et vir v. The JOHNS HOPKINS HOSPITAL et al.
• Court: Court of Special Appeals of Maryland

Page 196

22 Md.App. 196

322 A.2d 548

Anna M. RAITT et vir v. The JOHNS HOPKINS HOSPITAL et al.

No. 929.

Court of Special Appeals of Maryland.

July 19, 1974.

[322 A.2d 550] Marvin Ellin, Baltimore, with whom was Leonard Passano Baker, Jr., Baltimore, on the brief, for appellant.

Hugh E. Donovan and William A. Ehrmantraut, Rockville, for appellee The Johns Hopkins Hospital.

John F. King, Baltimore, with whom was Ward B. Coe, III, Baltimore, on the brief, for other appellee.

Before ORTH, C. J., and MOYLAN and MENCHINE, JJ.

ORTH, Chief Judge.

On 31 August 1972 Anna M. Raitt and Herman J. Raitt, her husband, appellants, filed a tort action in the Baltimore City Court against The Johns Hopkins Hospital and Andrew C. W. Montague, M.D., appellees. The basis of the suit was medical malpractice. On 19 October appellees pleaded the general issue. On 17 November, at the suggestion of appellees, the case was removed to the Circuit Court for Montgomery County. Maryland Rule 542. On 20 January 1974 it came on for trial before a jury, and, at the close of the evidence offered by appellants, the court granted appellees' motion for a directed verdict. Rule 552. On 4 February judgment was entered in favor of appellees for costs. Appellants noted an appeal the next day.

THE LAW RELATING TO MEDICAL MALPRACTICE

(1)

A physician is presumed to have performed his medical duties with care and skill. State, Use of Janney v. Housekeeper, 70 Md. 162, 16 A. 382. See Fink v. Steele, 166 Md. 354, 171 A. 49; McClees v. Cohen, 158 Md. 60, 148 A. 124. The presumption is rebuttable, and the failure to exercise requisite care or skill is tortious in nature. Benson v. Mays, 245 Md. 632, 227 A.2d 220. The want of the requisite care or skill in the performance of medical duties being negligent, a physician is liable for injuries directly caused thereby. The doctrine of res ipsa loquitur does not apply to medical malpractice, and the mere fact that an unsuccessful result follows medical treatment is not of itself evidence of negligence. Johns Hopkins Hospital v. Genda, 255 Md. 616, 258 A.2d 595; Bettigole v. Diener, 210 Md. 537, 124 A.2d 265. See Nolan v. Dillon, 261 Md. 516, 276 A.2d 36; Lane v. Calvert, 215 Md. 457, 138 A.2d 902. Therefore, the aggrieved party must show both a lack of the requisite care or skill on the part of the physician and that such want of care or skill was a direct cause of the injury; if 'In proving a malpractice case in Maryland, a plaintiff has the burden of proving: (1) the standard of medical skill and care ordinarily exercised in the particular locality; (2) a failure to observe that standard on the part of the physician-defendant; and (3) a showing that the defendant's failure to observe the proper standard was a direct cause of the injuries about which his patient complains in the malpractice action.'

                proof of either of these elements is lacking the case is not a proper one for submission to the jury.  State, Use of Kalives v. Baltimore Eye, Ear and Throat Hospital,  177 Md. 517, 10 A.2d 612; Angulo v. Hallar, 137 Md. 227, 112 A. 179.  The issue of professional care or skill '. . . is generally a topic calling for expert testimony only . . ..'  Fink v. Steele, supra, 166 Md. at 361, 171 A. at 52, quoting Wigmore on Evidence (2d Ed.), § 2090; Thomas v. Corso, 265 [322 A.2d 551] Md. 84, 97, 288 A.2d 379.  1  Thus, it is necessary that parameters be established through which the standard of care or skill may be expressed.  We find these parameters clearly established in Maryland.  The performance of the professional duties of a physician-defendant is tested by the amount of care or skill exercised generally by physicians engaged in the same field or specialty at the same time in the locality or community in which the physician-defendant was practicing.  State, Use of Solomon v. Fishel, 228 Md. 189, 195, 179 A.2d 349.  We summed it all up in Dunham v. Elder, 18 Md.App. 360, 363, 306 A.2d 568, 570
                

(2)

It is Dunham which gives rise to the primary issue on this appeal. The parties seem satisfied that the established law in Maryland is that the care or skill of the physician-defendant is to be measured against the amount In State, Use of Janney v. Housekeeper, supra, 70 Md. at 172, 16 A. at 384, the Court found no error in the grant of a prayer which told the jury that '.. . the degree of care and skill required is that reasonable degree of care and skill which physicians and surgeons ordinarily exercise in the treatment of their patients . . ..' In Dashiell v. Griffith, 84 Md. 363, 380-381, 35 A. 1094, 1096, the Court observed: 'The cases are generally agreed upon the proposition that the amount of care, skill, and diligence required is not the highest or greatest, but only such as is ordinarily exercised by others in the profession generally.' But the trial court had granted a prayer which told the jury that if they '. . . find from the evidence that . . . said amputation (of plaintiff's finger) was rendered necessary by the want of such reasonable skill, care and diligence in the treatment of said finger and of the said plaintiff, as is usually exercised by physicians and surgeons in good standing in the defendant's school of practice in this locality, then their verdict must be for the plaintiff.' At 364 (emphasis supplied). ⁴ In any event, in State, Use of Solomon v. Fishel, supra, the Court explicitly impressed the locality restriction on the degree of care and skill test, stating, at 195: 'The first question then with regard to the defendant's liability is whether or not he did fail to exercise the amount of care, skill and diligence as a physician and surgeon which is exercised generally in the community (the City of We find no departure by the Court of Appeals from the Fishel qualification to the Housekeeper standard. The qualification was expressly affirmed in subsequent cases. For example, in Tempchin v. Sampson, 262 Md. 156, 277 A.2d 67, stating that the liability of an optometrist to a patient is to be tested by standards analogous to those used to test physicians and surgeons, the Court used the Fishel language in expressing the standard-'whether or not he did fail to exercise the amount of care, skill and diligence as (an optometrist) which is exercised generally in the community . . . in which he was practicing by (other practitioners) in the same field.' At 159, 277 A.2d at 69. In Thomas v. Corso, supra, 265 Md. at 97, 288 A.2d at 387 the Court observed that '. . . in many medical malpractice cases expert testimony is required to be introduced by the plaintiff to establish the standard of care in the locality involved . . ..' In Kruszewski v. Holz, 265 Md. 434, 438, 290 A.2d 534, 537, the Court said: 'At trial both sides agreed, as they should, that Dr. Holz was required to adhere to the same standard of care in treating his patients as was practiced by other physicians engaged in this specialty in the community.' In those cases in which the locality qualification was not expressly included in stating the test, it appears that the standard was in fact applied in terms of the locality or community or that locality was not an issue. So in Nolan v. Dillon, supra, where, although the degree of care and skill was set out in the words of Dashiell v Dunham is not to be read as other than following the rule firmly established by the Court of Appeals. When we pointed out in Dunham that the experts offered had never been licensed to practice in Maryland, and had never practiced in this State, treated patients, enjoyed privileges in any hospital in Maryland or maintained an office here, we were not impressing additional requirements on the qualifications required by an expert to testify on the matter of local care or skill. We were merely noting the background of the physicians involved; we were not holding that that could not be familiar with the standard of care or skill in the community unless they were licensed to practice in Maryland, and actually practiced, treated patients, maintained an office, and enjoyed hospital privileges in the locality. If the evidence is sufficient to show fairly to the reasonable satisfaction of the trial judge that the expert witness proffered is familiar with the local standard concerned, that witness, otherwise qualified, may testify as an expert with respect to the standard.

                of care or skill exercised generally by physicians engaged in the same field in the community in which the physician-defendant performed the duties alleged to be improper.  They accept that Dunham did not change the existing rule; that the physician-defendant's conduct is to be measured against the standard of care or skill in the defendant's own community.  2  But where they are at odds is with respect to the qualifications of the expert witness who may testify with respect to that standard.  Appellants say that what is required is that the expert be familiar with the local standard.  Appellees claim that the teaching of Dunham is that the expert must have gained his knowledge by practicing or residing in the community involved.  The trial court also so construed Dunham.  3  Dunham does not so hold
                Baltimore) in which he was practicing by doctors engaged in the same field.  5  See Lane v. Calvert, 215 Md. 457, 462, 138 A.2d 902, and cases therein cited.'  6
                Griffith, supra, 7 the expert testified that the medical treatment by the defendant-physician, who practiced in Montgomery County, was '. . . not in conformity with the usual standard of skill and care ordinarily exercised by a physician specializing in obstetrics and gynecology, practicing in Montgomery County.'  261 Md. at 535, 276 A.2d at 46
                

We hold that the trial court, in ruling that the witnesses offered by appellants were not qualified as experts to give an opinion with respect to the standards of care of a physician in Baltimore City performing the particular surgical procedure involved, was wrong insofar as its ruling was...