Perforated Small Intestine

A perforation to the small intestine can sometimes occur during surgery. This is a very serious and dangerous injury if left unattended. I have experience handling medical malpractice issues in Maryland involving exactly this type of injury. In the course of removal of an ovary the OB/GYN accidentally nicked or cut the small intestine. It is generally agreed by certified OB/GYN's and board-certified general surgeons that nicking an internal organ is not in and of itself a deviation from the standard of care. However many will agree that the failure to initiate an examination of the internal organs prior to completing the surgery is a deviation from the standard of care. Specifically as it relates to a perforation of the small intestine a doctor should examine the small intestine prior to completing his surgery. This examination is done by first mobilizing the small intestine so that it can be visually accessed for inspection and secondly running the bowel. There is no guarantee that every nick will be discovered. But it is certain if this inspection procedure is not followed the nick will never be discovered.

If you a family member or friend have a question about a medical procedure and you believe you may be the victim of medical malpractice please feel free to call me. I am happy to answer your questions for you right over the phone at no cost to you. 1-888-760-7339

Maryland medical malpractice the certificate

As I have outlined in the prior post Maryland medical malpractice law requires a certification to establish that the defendant doctor has deviated from standard of care. In order to help eliminate frivolous lawsuits the certification requirement is fairly narrowly drawn. I am offering this post as a final review of a condensed version to simplify understanding the requirements of the certificate of merit.

The certificate of merit must contain the following information.

1. The educational and experience background of the attesting doctor. Pursuant to Maryland statute § 3-2A-02 of the Courts and Judicial Proceedings Article in pertinent part: In addition to any other qualifications, a health care provider who attests in a certificate of a qualified expert or testifies in relation to a proceeding concerning a defendant's compliance with or departure from standards of care:

Shall have had clinical experience,

provided consultation relating to clinical practice, or

taught medicine in the defendant's specialty or

a related field of health care, or

in the field of health care in which the defendant provided care or treatment to the plaintiff,

within 5 years of the date of the alleged act or omission giving rise to the cause of action; and

if the defendant is board certified in a specialty,

shall be board certified in the same or

a related specialty as the defendant.

this subparagraph does not apply if:

The defendant was providing care or treatment to the plaintiff unrelated to the area in which the defendant is board certified; or

The health care provider taught medicine in the defendant's specialty or
a related field of health care

2. The 20% Rule pursuant to Maryland statute § 3-2A-04 b(4)

A health care provider who attests in a certificate of a qualified expert or who testifies in relation to a proceeding before an arbitration panel or a court concerning compliance with or departure from standards of care may not devote annually more than 20 percent of the expert's professional activities to activities that directly involve testimony in personal injury claims. Professional activity includes(1) the time the doctor spends in, or traveling to or from, court or deposition for the purpose of testifying, waiting to testify, or observing events in preparation for testifying, (2) the time spent assisting an attorney or other member of a litigation team in developing or responding to interrogatories and other forms of discovery, (3) the time spent in reviewing notes and other materials, preparing reports, and conferring with attorneys, insurance adjusters, other members of a litigation team, the patient, or others after being informed that the doctor will likely be called upon to sign an affidavit or otherwise testify, and (4) the time spent on any similar activity that has a clear and direct relationship to testimony to be given by the doctor or the doctor's preparation to give testimony.

3. The applicable standard of care

4. The specific identification of each defendant

5. The specific manner in which each individual defendant breached the standard of care. Articulated within a reasonable degree of medical probability.

6. A specific factually based statement as to each defendant and how the breach of the standard of care caused the injury. Articulated within a reasonable degree of medical probability.

7. No Affiliation the attesting doctor must also state: he/sheis not a party to the pending litigation; that he/she is not an employee or partner of any party to the pending litigation; that he/she is not an employee or stockholder of any professional corporation of which any party of the pending litigation is a stockholder

It is essential that your certificate of merit complying with the Maryland statute The courts Maryland have determined that compliance with the requirements is a condition precedent to filing your malpractice action. A defective certificate of merit is an issue that can be raised at any stage during the litigation. As such there is the potential you could complete your trial, win, and the defendants raise a defective certificate of merit issue. To the extent this issue is raised and the defendants prevail and the statute of limitations has expired you may be barred from refiling your claim.

Maryland Medical Malpractice requirements of the certificate of merit

Recently, in Barber v. Catholic Health Initiatives, Inc., 174 Md.App. 314, 921 A.2d 811 (2007), the intermediate appellate court examined previous health care claims cases of this State, including this Court's decision in Walzer, and determined that the identity of the physicians who allegedly breached the standard of care must be discernable from the Certificate, and that a failure to do so will result in dismissal. In that case, the claimant named all twelve defendants in the original claim and defined them collectively as the "Health Care Providers." The court determined that it was clear from the Certificate, about whom the physician was speaking, when the attesting physician explained that the "Health Care Providers" breached the standard of care. The court stated that "[t]he Certificate cannot be analyzed in a vacuum; it must be considered in the context of the Statement of Claim that it supported, which had already been filed with the HCAO." The court noted, however, that "[t]o be sure, if appellants had re-named in the Certificate each person or entity listed in the Statement of Claim, this appeal would have been avoided." Barber, 174 Md.App. at 351, 921 A.2d at 833. I agree that the inclusion of the specific names is the better practice, as Dr. Simmons-Clemmons indicated in her amended Certificate.

Maryland Medical Malpractice Certificate of Merit

A medical malpractice action in Maryland commences only after a certificate of merit is executed by a medical professional attesting to the deviation from the standard of care by the defendant doctor. The Maryland legislature has placed restrictions on which doctors can successfully execute a certificate of merit. see MD Code Cts. & Jud. Proc. 3-2A-04. This was done primarily to eliminate the potential for frivolous lawsuits being filed against doctors andospitals wih the expectation that malpractice insurance cost and the cost of medical services to patients would be reduced. The statute restrictions as to who can attest to a deviation from the standard of care essentially boil down to activites, experience, and affiliation. For example an attesting doctor who intends to offer testimony concerning compliance with or departure from standards of care may not devote annually more than 20 percent of the expert's professional activities to activities that directly involve testimony in personal injury claims. Similarly as to the credentials of an attesting see Section 3-2A-02 Exclusiveness of procedures it states
(2) (i) This paragraph applies to a claim or action filed on or after January 1, 2005
(ii) 1. In addition to any other qualifications, a health care provider who attests in a certificate of a qualified expert or testifies in relation to a proceeding before a panel or court concerning a defendant's compliance with or departure from standards of care:

A. Shall have had clinical experience, provided consultation relating to clinical practice, or taught medicine in the defendant's specialty or a related field of health care, or in the field of health care in which the defendant provided care or treatment to the plaintiff, within 5 years of the date of the alleged act or omission giving rise to the cause of action; and B. Except as provided in item 2 of this subparagraph, if the defendant is board certified in a specialty, shall be board certified in the same or a related specialty as the defendant.

2. Item (ii)1.B of this subparagraph does not apply if:

A. The defendant was providing care or treatment to the plaintiff unrelated to the area in which the defendant is board certified; or B. The health care provider taught medicine in the defendant's specialty or a related field of health care.

If you have questions about a medical malpractice case in Maryland please feel free to call me at 1-888-760-7339

Interrogatories Maryland personal injury case filed in the District Court

There are times when a personal injury case is most appropriately filed in the District Court as opposed to the circuit court. The rules of procedure between the two different court settings will affect the timing for issuing discovery to the defendant you are suing. One example is the timing for issuing discovery interrogatories to the defendant. The Maryland rules require that the plaintiff must serve discovery interrogatories on the defendant no later then 10 days after receiving notice from the court that the defendant has filed his notice of intention to defend. As such it is good practice in the District Court particularly to serve your discovery request at the same time you serve your complaint on the defendant. Otherwise it is equally important to carefully calendar the due dates for issuing discovery, responding to discovery request, and filing your notice of intention to enter records into evidence.

If you have questions on these or any other subjects affecting personal injury in Maryland please feel free to visit MarylandinjuryAttorney.net or feel free to call me at 1-888-760-7339

Pre-trial Statement Maryland Personal Injury Lawyer

In every personal injury case in Maryland that has been filed in the Circuit Court or subsequently transferred to the Circuit Court on a defendant's request for jury trial there will be a requirement that both parties file a pretrial statement. The content for a pretrial statement has already been predetermined by the Maryland rules. I have outlined below the rules affecting the filing of a pretrial statement.
Rule 2-504.2. Pretrial conference.

(a) Generally.- The court, on motion or on its own initiative, may direct all parties to appear before it for a conference before trial. If the court directs, each party shall file not later than five days before the conference a written statement addressing the matters listed in section (b) of this Rule.

(b) Matters to be considered.- The following matters may be considered at a pretrial conference:


(1) A brief statement by each plaintiff of the facts to be relied on in support of a claim;


(2) A brief statement by each defendant of the facts to be relied on as a defense to a claim;


(3) Similar statements as to any counterclaims, cross-claim, or third-party claim;


(4) Any amendments required of the pleadings;


(5) Simplification or limitation of issues;


(6) Stipulations of fact or, if unable to agree, a statement of matters of which any party requests an admission;


(7) The details of the damage claimed or any other relief sought as of the date of the pretrial conference;

(8) A listing of the documents and records to be offered in evidence by each party at the trial, other than those expected to be used solely for impeachment, indicating which documents the parties agree may be offered in evidence without the usual authentication and separately identifying those that the party may offer only if the need arises;

(9) A listing by each party of the name, address, and telephone number of each non-expert whom the party expects to call as a witness at trial (other than those expected to be used solely for impeachment) separately identifying those whom the party may call only if the need arises;


(10) A listing by each party of those witnesses whose testimony is expected to be presented by means of a deposition (other than those expected to be used solely for impeachment) and a transcript of the pertinent portions of any deposition testimony that was not taken stenographically;

(11) A listing by each party of the names and specialties of experts the party proposes to call as witnesses;

(12) Any other matter that the party wishes to raise at the conference.


If you have questions regarding the filing of a pretrial statement please feel free to call me 1-888-760-7339