Reporter Immunity: Monroe v. UMMC 1

The Baltimore Medical Malpractice Lawyer Blog regularly discusses Maryland appellate opinions in medical malpractice cases, usually based on negligence. On May 24, 2024, the Appellate Court of Maryland issued an unreported opinion in Monroe v.  University of Maryland Medical Center, LLC (“UMMC”), No. 1550. That case also asserted claims in the setting of medical care, but they were intentional torts not negligence. This Blog post looks at the first holding that the Appellate Court discussed involving reporter immunity. The Appellate Court held that the circuit court properly denied summary judgment on the issue of lack of good faith in reporting the abuse or neglect of a child. Future Blog posts will discuss other holdings from this case.

Facts on Reporter Immunity

The Plaintiff, Ms. Monroe, had two daughters, ages 5 and 6, who had flu symptoms. She gave them several brands of over-the-counter cough medicine over a few days. (Op. at 4, 6). Ms. Monroe called 911 to report that her children, half-sisters, were unconscious and barely breathing. Afterward, an ambulance took them to UMMC. (Id. at 1).

At the emergency room, the staff administered a battery of tests, including VITROS rapid urine tests. That test came back positive for opiates in both children. The staff treated them for acute respiratory failure, intubated them, and they remained in comas and on ventilators for several days. (Id. at 1).

Ms. Monroe told the UMMC toxicologist, Dr. Kim, about giving the kids several brands of OTC medications for flu symptoms. She theorized they were to blame for the kids’ condition. Dr. Kim noted in his records that he disagreed and that there are no known false positives of opiates due to DXM, the active ingredient in the OTC medications. (Id. at 6-8).

The police notified the Department of Social Services (DSS), and the reporter immunity issue arose when the doctors shared the results of the VITROS. UMMC then received blood test results, which were negative for opiates. UMMC promptly notified DSS. The hospital discharged the kids after 11 days, but they would not go home to their mother for four months. The court system removed the children from Ms. Monroe. Still, ultimately, the court adjudicated the children not to be children in need of assistance (CINA). The children made a full medical recovery. (Id. at 1-2). However, tragically, three years later, the older daughter died by suicide. (Id. at 2). 

Lawsuit

The mother and her kids brought suit against UMMC, the emergency physicians’ group, and toxicologist Dr. Kim in the Circuit Court for Baltimore City. Plaintiffs alleged that Dr. Kim started rumors that the kids had overdosed on opiates, instigating DSS to open investigations and driving official proceedings in the face of contradictory evidence. (Id. at 2, 7).

The plaintiffs’ claims included intentional infliction of emotional distress (IIED), false imprisonment, intentional misrepresentation, constructive fraud, and malicious prosecution. They asserted that family members who worked at UMMC said that Dr. Kim spread rumors to persons not involved in the treatment that the mother permitted her children to gain access to opiates and that she was a child abuser.  The plaintiffs also alleged that Dr. Kim told social services that the urine test was more accurate than the blood test. They allege Dr. Kim acted maliciously and reported the VITROS results in bad faith. (Id. at 12-13).

The defendants sought summary judgment on reporter immunity.

Appellate Court on Reporter Immunity

The Appellate Court of Maryland first looked at the initial denial of summary judgment on statutory immunity early in the case. The defense contended that they were entitled to summary judgment under CJP 5-620 and FL 5-708 as persons who, in good faith, make a report of abuse or neglect of a child.

The Appellate Court has defined good faith in the reporter immunity law: “An intangible and abstract quality that encompasses, among other things, an honest belief, the absence of malice, and the absence of design to defraud or to seek an unconscionable advantage.” Catterton v. Coale, 84 Md. App. 337, 342 (1990). Bad faith means “not simply bad judgment or negligence, but it implies a dishonest purpose or some moral obliquity and a conscious doing of wrong.” (Id.).

In addition, courts have held that the law does not require the reporter to make an independent investigation to determine whether there is exculpatory evidence (Op. at 83).

The Appellate Court examined whether there was a genuine dispute about whether the defendants acted in good faith. The court noted that the plaintiffs had expert testimony challenging Dr. Kim’s reliance on the VITROS testing.  They also alleged that racial and economic animus drove the defendants’ actions. The court also observed that the American Medical Association (AMA) has acknowledged that many patients suffer discrimination when receiving health care. (Id. at 81).

The circuit court found the mother’s testimony that the defendants were disregarding her views and treating her disrespectfully compelling. The Appellate Court stated that it rarely overturns a denial of a motion for summary judgment where good faith is the issue and would not do so here (Id. at 92).

Commentary by the Baltimore Medical Malpractice Lawyer on Reporter Immunity

In this case, the Appellate Court’s holdings reflect the plaintiffs’ challenges, particularly in proving a lack of good faith and scientific matters. We must view the Appellate Court’s upholding of the denial of summary judgment in the context of the deferential abuse of discretion standard, which “rarely” results in reversal for denial of summary judgment. Similarly, the circuit court denied summary judgment on the issue of good faith in reporter immunity, where it is “ordinarily” not a matter for summary judgment. Examination of the evidence shows how, when viewed individually, there can be alternative explanations. Still, together, it can form a picture that overcomes summary judgment.

Evidence

AMA report on discrimination in medical care. Such conduct is unacceptable. This report shows that racial discrimination occurs in these situations but does not establish it happened here.

Plaintiff’s Expert: The plaintiffs had an expert toxicologist who opined that Dr. Kim was wrong when he said that cough syrup could not cause a false positive for opiates. The law is clear that being wrong alone does not constitute bad faith. This evidence can support a lack of good faith but can also exist without it.

Dr. Kim’s Involvement in the Investigation: Plaintiffs alleged that Dr. Kim was the “driving” force behind the DSS investigation. The evidence, however, can also be viewed as involving no unusual involvement by Dr. Kim.

The plaintiffs alleged that UMMC employees told the mother that UMMC was spreading rumors about her. The Court’s opinion does not reveal the plaintiffs producing any such evidence.

The circuit court found compelling evidence that the defendants disregarded Ms. Monroe’s views and treated her disrespectfully. This finding is important because the circuit court assesses the witnesses in person. It can certainly support a finding of lack of good faith. However, this mistreatment can also be unacceptable conduct that does not equate with dishonesty.

Dr. Kim’s Reporter Immunity

Interaction between Dr. Kim and Ms. Monroe. Ms. Monroe once spoke with Dr. Kim but did not recall the conversation. She said Dr. Kim said that typically when you see cases like this, there is a positive blood sample from whatever drug your children ingested. Dr. Kim further stated that they would do a drug panel, and one of the drugs would come up positive. Mrs. Monroe then questioned, a typical case for who? (Id. at 18).

Mrs. Monroe further attributed her racial claims to “the entire University of Maryland staff” because they did not listen to her explanation of the OTC medications and only focused on illegal drugs. She felt the University of Maryland saw her as a black woman from her neighborhood. There were also looks and stares. (Id. at 19).

Ms. Monroe also attributed a racial comment to an unidentified white UMMC employee who said two black children with two different fathers would not have a specific metabolism disorder, which was not prominent in blacks but is in whites and Asians. (Id. at 19-20).

The “typical” comment and metabolism comment can be motivated by racial and economic discrimination or have completely innocuous explanations. The other evidence could indicate racial animus or be Ms. Monroe’s subjective interpretation.

Conclusion

Proving a lack of good faith based on racial and economic discrimination can be challenging. Defendants rarely document discriminatory intent. In this case, there were factors that, each alone, could have innocuous explanations. However, together the courts found that the factors supported a finding of lack of good faith for reporter immunity that resulted in denial of summary judgment.

This is a close question that jurists can disagree on. For example, one member of the Appellate Court panel wrote a concurring opinion in which he stated that the standard of review was de novo, not abuse of discretion. In writing that he would have granted summary judgment, he stated: “Unsupported allegations of racial and economic animus and assertions that Dr. Kim could have second guessed the VITROS test result are insufficient to create a question of fact as to the good faith of the mandatory reporter.” (Conc. Op. at 2).

Spoiler alert:  In a later blog post on this case opinion, I will discuss how the result changed when the court removed one of these pieces (Plaintiff’s expert) from the picture.

Additional Reads

In part 2 of the Blog series on Monroe v. UMMC, you can read about the court’s analysis of late motions to compel.

For a discussion of healthcare provider immunity in the context of the COVID-19 pandemic, see this Blog’s post in Constantine v. BWEP.

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.