In this medical malpractice case, the Plaintiff Martinez sued Defendant Johns Hopkins Hospital (“Johns Hopkins”) claiming that Johns Hopkins negligently failed to perform a timely Caesarean section, causing Mr. Martinez to suffer from cerebral palsy, retardation, and other disorders. The Court of Special Appeals heard an appeal by the Plaintiff Mr. Martinez after a jury in the Circuit Court in Baltimore City awarded Mr. Martinez $4 million for lost wages, $25 million for future medical expenses, and $26 million in non-economic damages. The trial court reduced the jury’s $26 million award for non-economic damages to $680,000. Mr. Martinez appealed that decision, arguing that Maryland’s cap on non-economic damages violated the separation of powers doctrine under the Maryland Declaration of Rights and was unconstitutional. Johns Hopkins filed a cross-appeal claiming that the circuit court abused its discretion in its evidentiary rulings by precluding evidence regarding the standard of care applicable to nurse-midwives, and by precluding evidence of a breach of that standard of care by a nurse-midwife treating Martinez’s mother, Ms. Fielding. The Court of Special Appeals held that Maryland’s cap on non-economic damages was not unconstitutional and that the circuit court erred in precluding the evidence and remanded the case to the circuit court.
The case arose after Ms. Fielding gave birth to Mr. Martinez on March 26, 2010. Ms. Fielding elected to have a natural birth at home, with the assistance of a registered nurse-midwife (“Ms Muhlhan”). After Ms. Fielding went into labor at her home, Ms. Muhlhan attempted to expedite the delivery by applying fundal pressure to Ms. Fielding and injecting her multiple times with Pitocin, a hormone which increases the strength and frequency of contractions. When her attempts were unsuccessful, Ms. Muhlhan called an ambulance to take Ms. Fielding to Johns Hopkins. Ms. Fielding arrived at Johns Hopkins at 3:30 a.m. At 3:45 a.m., the physicians at Johns Hopkins determined that Ms. Fielding needed an urgent Caesarean section. The physicians first drew blood from Ms. Fielding to test it to determine if it would be safe to administer anesthesia to Ms. Fielding during the procedure. Once the results of the blood test were returned, the physicians performed the Caesarean section and delivered Martinez at 5:40 a.m. He now suffers from cerebral palsy, retardation, and other disorders.
Mr. Martinez, by and through his parents, sued Johns Hopkins, alleging that the hospital negligently failed to perform a timely Caesarean section causing Mr. Martinez’s injuries. Johns Hopkins argued that the nurse-midwife, Ms. Muhlhan was solely responsible for Mr. Martinez’s injuries, prior to Ms. Fielding’s arrival at the hospital. The trial court, however, refused to allow Johns Hopkins to introduce evidence of the standard of care of a nurse-midwife, determining that the evidence was not relevant because even if Ms. Muhlhan breached the standard of care, it would not excuse a breach by John Hopkins of its own standard of care.
The Court of Special Appeals found that, although the trial judge’s inferences were reasonable, he failed to consider the possibility that Ms. Muhlhan breached her standard of care and the breach was the sole cause of Mr. Martinez’s injuries. The Court found, however, that Maryland had never decided whether a party could defend itself with evidence of a non-party’s negligence. The Court reviewed case law from other jurisdictions and held that evidence of negligence and causation attributable to a non-party is relevant when the defendant, such as Johns Hopkins, asserts a complete denial of liability. Therefore the Court found that evidence of the nurse-midwife standard of care and Ms. Muhlhan’s breach of that standard of care were relevant to Johns Hopkins defense and should have been admitted, so the jury could determine who caused Martinez’s injuries. Finally, the Court held that it is well settled in Maryland that a cap on non-economic damages is constitutional, but stated that the issue was moot because it would remand the case for a new trial based on its resolution of the evidentiary issues.