The Supreme Court of Maryland holds that a registered nurse may serve as the certificate of qualified expert under the Maryland Health Care Malpractice Claims Act when the alleged negligence involves matters within the scope of nursing practice, so long as the expert satisfies the peer-to-peer requirement.

Canton Harbor Healthcare Center, Inc. v. Felicia Robinson, et al., No. 22, September Term, 2024. Opinion by Biran, J.  

        An individual (“deceased”) was transferred to Canton Harbor Healthcare Center, Inc. (“Canton Harbor”), a skilled nursing facility, for in-patient follow-up care following a stroke. During his treatment at Canton Harbor, he developed pressure ulcers. He was transferred to other facilities, where the ulcers worsened, he became septic and passed away.

        Deceased’s wife (“Plaintiff”) brought a wrongful death suit against Canton Harbor for claims of negligence, alleging that Canton Harbor breached the standard of care by allowing his ulcers to develop, spread, and become infected, which wrongfully caused his death. During arbitration, Plaintiff filed a certificate of qualified expert Anjanette Jones-Singh, a registered nurse, who attested that the facility breached the standard of care, proximately causing the development of the deceased’s ulcers. Canton Harbor filed a Motion to Dismiss, arguing that Jones-Singh was not qualified to attest to the proximate cause since she is a registered nurse. The court granted the Motion to Dismiss and Plaintiff appealed to the Appellate Court of Maryland, arguing that she brought the claim against a skilled nursing facility, and not a physician, which would fulfill the peer-to-peer review requirement under the Health Care Malpractice Claims Act. The Appellate Court of Maryland held that a registered nurse is not “per se disqualified” to attest that failure to adhere to such standards proximately caused the deceased’s injuries, vacated the dismissal, and remanded the case for further proceedings. Thereafter, Canton Harbor filed a petition for writ of certiorari, which the Supreme Court of Maryland granted.

        Under the Health Care Malpractice Claims Act (“the Act”), a plaintiff alleging medical negligence must file a certificate of a qualified expert attesting that the defendant breached the applicable standard of care and that the breach proximately caused the alleged injury. In addition, the Act requires a peer-to-peer relationship between the defendant and attesting expert. The qualifications for a peer-to-peer relationship include “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 five (5) years of the date of the alleged act or omission giving rise to the cause of action.”

        The Supreme Court of Maryland rejected a categorical rule barring nurses from serving as certificate experts. The Court held that a nurse qualifies as a “health care provider” under the Act and may provide the required certification when the alleged negligence falls within the scope of nursing practice. In the context of skilled nursing care, the Court explained prevention and treatment of ulcers, patient monitoring, and implementation of care plans are often nurse’s responsibilities rather than physicians. Accordingly, a nurse may be qualified to opine on breach of the nursing standard of care, so long as the opinion does not extend into matters requiring physician expertise and they meet the peer-to-peer requirement of the Act.

        This ruling widens the scope of applicable experts for various negligence-based actions and indicates that challenges to an expert’s qualifications will likely focus more on the precise nature of the alleged negligence and whether the opinions offered remain within the expert’s field of practice. 

- Allison Commess, Law Clerk