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Negligence Instructions: Armacost v. Davis 1
The Baltimore Medical Malpractice Lawyer Blog examines legal issues in Maryland medical malpractice cases. In this post, I discuss a case in which the plaintiff underwent neck surgery, which led to an infection and subsequent health issues. The legal issues revolve around using general negligence instructions in a medical malpractice case. To provide a quick overview, the plaintiff filed a suit against the defendant, a neurosurgeon, for breaching the standard of care and failing to obtain informed consent. The case went through the Circuit Court for Baltimore County, the Court of Special Appeals, and finally, the Court of Appeals, which is the focus of this post. The Court of Appeals’ reported opinion in is Armacost v. Davis, 462 Md. 504 (2019).
Factual Background on General Negligence Jury Instructions
The plaintiff underwent surgery on his neck in which the neurosurgeon removed discs and fused vertebrae. (Op. at 1,3). An infection developed, and the plaintiff developed with neck pain and limited range of motion. (Id. at 3).
The plaintiff filed suit in the Circuit Court for Baltimore County. The plaintiff asserted that the defendant breached the care standard and failed to obtain informed consent. (Id. at 4).
Jury Instructions
At trial, when the circuit country instructed the jury, it primarily used the pattern jury instructions. This appeal focused on three of the instructions. The circuit court gave general instructions on negligence and foreseeability as follows:
“Negligence is doing something that a person using reasonable care would not do or not doing something that a person using reasonable care would do. Reasonable care means that caution, attention or skill a reasonable person would use under similar circumstances. A reasonable person changes conduct according to the circumstances and the danger that is known or would be appreciated by a reasonable person. Therefore, if the foreseeable danger increases, a reasonable person acts more carefully.” (Id. at 7).
The circuit court also instructed on the negligence of a healthcare provider:
“A health care provider is negligent if the health care provider does not use that degree of care and skill which a reasonably competent health care provider engaged in a similar practice and acting in similar circumstances would use.” (Id. at 8).
Defense Objection
The defense objected to the foreseeability instruction as not applicable. It also argued that it confused whether the doctor had to see into the future and, therefore, have a heightened duty to foresee a bad outcome. This potential confusion related to the informed consent claim. (Id. at 9-10).
The jury found the defendants negligent and awarded $329,000 in damages. The jury found for the defense on the informed consent claim. (Id. at 14).
The doctor appealed the decision of the Court of Special Appeals, a higher court than the Circuit Court. The Court of Special Appeals reversed. The plaintiff appealed. The Court of Appeals, which is the focus of this post, is responsible for reviewing the decisions of lower courts and has the final say in legal matters in Maryland. (Id. at 15).
Court of Appeals
The general principles that govern negligence also apply to medical malpractice claims. The standard of care in a negligence action is whether a reasonable person in similar circumstances. (Id. at 18). Accordingly, the standard of care for a doctor is a reasonably competent practitioner in the same specialty in similar circumstances. (Id. at 19-20).
The Court of Appeals noted that it had never held that giving general negligence instructions in a medical malpractice case is an error. (Id. at 21). The court stated that general negligence instructions are not wrong or misleading. However, it noted that it is helpful to expressly state that the general negligence instructions are a preface to the particular medical malpractice instructions. (Id. at 25).
Prejudice
The court then turned to whether the defendants established the instruction had prejudiced them. (Id.). The court found that the existence of prejudice was close to nil. No one suggested that the defendant was to be measured by a reasonable person. On the contrary, lawyers for both sides repeatedly said that the standard was a reasonable doctor. (Id. at 26). In any event, the general negligence instruction is a lesser standard than the doctor’s standard so that the application would have benefitted the defendant. (Id. at 27-28).
The court then turned to the foreseeability instruction. The court again noted that no decision had banned the general foreseeability instruction in a medical malpractice case (Id. at 30). In addition, it caused no prejudice. The defense’s concern was confusion with the informed consent claim. However, the defense prevailed on that claim. (Id. at 31-32).
Accordingly, the court’s comprehensive analysis concluded that the circuit court did not abuse its discretion in giving the general negligence jury instructions. Nor did the defense establish the prejudice required to overturn a jury verdict, demonstrating the court’s thoroughness and commitment to justice. (Id. at 38).
Commentary by the Baltimore Medical Malpractice Lawyer on General Negligence Jury Instructions
This decision was straightforward for the Court of Appeals. At trial, the defendant did not even complain about the general negligence instruction on the standard of care. Only after winning a surprising victory in the Court of Special Appeals did the defendant try to make that issue the more important of the two negligence instruction issues. The Court’s clear and decisive ruling serves as a testament to the fairness of the legal process. (Id. at 19).
The circuit court’s instructions clearly showed that the specific instruction on the doctor’s standard of care applied the general negligence standard. Moreover, throughout the trial, lawyers for both sides repeatedly applied the doctor-specific standard.
As for the foreseeability instruction, the only concern the defense expressed at trial was confusion about the informed consent claim. Since the defense won that claim, there is no possibility of prejudice.
The Court of Appeals quickly dispatched these issues. In part 2 of this Blog post, I will discuss the Allen charge issue, another important aspect of this case. The Allen charge, also known as the ‘dynamite charge ‘, is a supplemental jury instruction given when the jury is deadlocked and unable to reach a verdict. I will explore its implications for medical malpractice law.
Mark Kopec is a top-rated Baltimore medical malpractice lawyer. Contact us at 800-604-0704 to speak directly with Attorney Kopec in a free consultation. The Kopec Law Firm is in Baltimore and helps clients throughout Maryland and Washington, D.C. Thank you for reading the Baltimore Medical Malpractice Lawyer Blog.