Case Title: Salerno v. Spectrum Medical Group, P.A.

Citation: 

Docket Number: 2019 ME 139

State: maine

Court: Maine Supreme Court

Date: 2019-08-20T00:00:00Z

Document:
MAINE SUPREME JUDICIAL COURT 
Reporter of Decisions 
Decision: 
2019 ME 139 
Docket: 
Yor-18-512 
Submitted 
On Briefs: June 26, 2019 
Decided: 
August 20, 2019 
 
Panel: 
SAUFLEY, C.J., and ALEXANDER, MEAD, GORMAN, HJELM, and HUMPHREY, JJ. 
 
 
ANN SALERNO 
 
v. 
 
SPECTRUM MEDICAL GROUP, P.A. 
 
 
HJELM, J. 
[¶1]  In December of 2017, Ann Salerno filed a complaint in the Superior 
Court (York County) against Spectrum Medical Group, P.A., stating a claim for 
personal injury based on premises liability.  In her complaint, Salerno alleged 
that more than three years earlier she slipped, fell, and sustained injuries in the 
locker room of a facility “owned and run” by Spectrum.  Spectrum moved for 
the court to dismiss Salerno’s complaint on the ground that, in reality, the claim 
was for medical negligence, which must be brought in accordance with the 
procedural requirements of the Maine Health Security Act (MHSA), 24 M.R.S. 
§§ 2501-2988 (2018).  The court (O’Neil, J.) entered an order denying 
Spectrum’s motion, and Spectrum appeals that order.  We agree with Spectrum 
that this interlocutory appeal falls within an exception to the final judgment 
 
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rule.  Reaching the merits, we affirm the order denying Spectrum’s motion to 
dismiss.   
I.  BACKGROUND 
 
[¶2]  The following facts are drawn from Salerno’s complaint, which are 
deemed admitted for purposes of this appeal, see Lawson v. Willis, 2019 ME 36, 
¶ 2, 204 A.3d 133, and from the procedural record. 
 
[¶3]  In June of 2014, Salerno underwent hip replacement surgery, after 
which she was required to follow strict precautions to protect her new hip.  Two 
months after the surgery, on August 6, 2014, Salerno went to a facility in Saco 
owned by Spectrum to engage in water therapy.  Although the water therapy 
itself took place in an area of the premises that was operated by a different 
entity, Spectrum operated a locker room where Salerno changed from her 
swimsuit into her street clothes.  Because of the surgery, Salerno needed to use 
a bench to change her clothes.  That day, however, the only bench in the locker 
room was covered by a heavy rubber mat that should have been on the floor in 
front of a nearby shower stall.  The shower stall had a handicapped-accessible 
seat, which Salerno attempted to use because the bench was not available.  
While attempting to get to the seat in the shower stall, Salerno slipped, fell, and 
was injured.   
 
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[¶4]  More than three years later, on December 11, 2017, Salerno filed a 
complaint against Spectrum stating a tort claim for premises liability.  Spectrum 
moved to dismiss Salerno’s claim, see M.R. Civ. P. 12(b)(6), asserting that the 
facts alleged in the complaint actually constitute an action for professional 
negligence as defined by the MHSA, see 24 M.R.S. § 2502(6), and that her claim 
is therefore controlled by that Act, see id. § 2903(1) (stating “[n]o action for 
professional negligence may be commenced until the plaintiff has” complied 
with the requirements of this section).  Spectrum further asserted that because 
the MHSA provides a three-year statute of limitations for “actions for 
professional negligence,” id. § 2902, Salerno’s complaint was time-barred.   
 
[¶5]  In an order issued in November of 2018, the court denied 
Spectrum’s motion, concluding that Salerno’s claim, as alleged, does not arise 
out of the provision or failure to provide healthcare services within the 
meaning of the MSHA, see 24 M.R.S. § 2502(6), and therefore Salerno’s claim 
“does not fall under the MHSA and was timely commenced,” see 14 M.R.S. § 752 
(2018) (stating that “[a]ll civil actions shall be commenced within 6 years after 
the cause of action accrues . . . except as otherwise specially provided”).  
Spectrum filed this interlocutory appeal challenging the court’s denial of its 
motion to dismiss.  See 14 M.R.S. § 1851 (2018).   
 
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II.  DISCUSSION 
 
[¶6]  Before we can consider the merits of Spectrum’s contentions on 
appeal, we must first address whether those contentions are cognizable at this 
stage of the case. 
A. 
Interlocutory Appeal 
 
[¶7]  “The denial of a motion to dismiss is not a final judgment, and 
ordinarily we would dismiss the appeal from the denial as an interlocutory 
appeal.”  Efstathiou v. Aspinquid, Inc., 2008 ME 145, ¶ 23, 956 A.2d 110.  “A party 
urging that we reach the merits of an otherwise interlocutory appeal has the 
burden of demonstrating to us that . . . [an] exception[] to the final judgment 
rule justifies our reaching the merits of the appeal.”  Sanborn v. Sanborn, 2005 
ME 95, ¶ 6, 877 A.2d 1075.  Spectrum contends that this interlocutory appeal is 
excepted from the final judgment rule because it falls within the death knell 
exception.1    
                                         
1  Spectrum also contends that its challenge is cognizable on appeal either pursuant to the judicial 
economy exception to the final judgment rule or because there exist extraordinary circumstances 
justifying an ad hoc exception to that rule.  For the following reasons, neither assertion is persuasive. 
First, the judicial economy exception to the final judgment rule arises only “in those rare cases in 
which appellate review of a non-final order can establish a final, or practically final, disposition of the 
entire litigation.  It applies only when a decision on the appeal . . . regardless of what it is, would 
effectively dispose of the entire case.”  Bond v. Bond, 2011 ME 105, ¶ 12, 30 A.3d 816 (alteration in 
original) (quotation marks omitted).  That is not the case here because if we were to affirm the court’s 
decision—as we do—the case would remain pending.   
 
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[¶8]  The death knell exception to the final judgment rule justifies 
consideration of issues raised on an interlocutory appeal only if awaiting a final 
judgment will cause “substantial rights of a party [to] be irreparably lost.”  Fiber 
Materials, Inc. v. Subilia, 2009 ME 71, ¶ 14, 974 A.2d 918 (quotation marks 
omitted).  “A right is irreparably lost if the appellant would not have an effective 
remedy if the interlocutory determination were to be vacated after a final 
disposition of the entire litigation.”  Id. (quotation marks omitted).  This 
exception is available “only when the injury to the appellant’s claimed right, 
absent appeal, would be imminent, concrete and irreparable.”  Id. ¶ 16 
(quotation marks omitted); see e.g., Geary v. Stanley Med. Research Inst., 2008 
ME 9, ¶ 11, 939 A.2d 86 (the denial of summary judgment based on the defense 
of immunity is immediately reviewable); Morse Bros., Inc. v. Webster, 2001 ME 
                                         
Second, the circumstances of this appeal are not so “extraordinary” as to allow an ad hoc exception 
to the final judgment rule.  Compare Fitzgerald v. Bilodeau, 2006 ME 122, ¶ 5, 908 A.2d 1212 
(concluding that absent extraordinary circumstances, “an immediate appeal from a denial of a motion 
to dismiss for forum non conveniens under the Uniform Child Custody Jurisdiction and Enforcement 
Act . . . is inappropriate”), and IHT Corp. v. Paragon Cutlery Co., 2002 ME 68, ¶ 7, 794 A.2d 651 
(concluding that the denial of a motion to dismiss for lack of personal jurisdiction does not constitute 
extraordinary circumstances), with First Nat’l Bank of Bos. v. City of Lewiston, 617 A.2d 1029, 1030-31 
(Me. 1992) (concluding that “extraordinary circumstances” are present where an appeal is taken 
from an interlocutory order permitting the sale of property for the benefit of an interest holder but 
in which the appellant claims to have a senior interest, because “a later finding that the [appellant] 
was indeed the holder of a senior interest would be hollow”), and Bar Harbor Banking & Tr. Co. v. 
Alexander, 411 A.2d 74, 77 (Me. 1980) (concluding that to avoid “judicial interference with 
apparently legitimate executive department activity . . . and to safeguard the separation of powers,” 
we will consider an interlocutory appeal); see also Estate of Dore v. Dore, 2009 ME 21, ¶ 16, 965 A.2d 
862. 
 
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70, ¶ 15, 772 A.2d 842 (the denial of a special motion to dismiss pursuant to 
anti-SLAPP legislation is immediately reviewable), abrogated in part by Nader 
v. Me. Democratic Party, 2013 ME 51, ¶ 12 n.9, 66 A.3d 571 (stating the correct 
standard of review for a special motion to dismiss); Moffett v. City of Portland, 
400 A.2d 340, 343 n.8 (Me. 1979) (the denial of a motion for a preliminary 
injunction to enjoin the disclosure of confidential records is immediately 
appealable).   
[¶9]  The determination of whether the death knell exception is 
applicable to a particular case rests on a fact-specific analysis.  See Fiber 
Materials, Inc., 2009 ME 71, ¶ 14, 974 A.2d 918.  We must therefore consider 
whether the MHSA in particular provides Spectrum with substantial rights and, 
if so, whether those rights will be irreparably lost if the court’s order denying 
the motion to dismiss is not reviewable until a final judgment is entered.   
 
[¶10]  As we have explained, in the mid-1970s the Legislature was faced 
with “an alleged national crisis in the availability and cost of medical 
malpractice insurance.”  Butler v. Killoran, 1998 ME 147, ¶ 9, 714 A.2d 129.  As 
a result, the Legislature enacted the MHSA as “comprehensive tort reform 
within the health care industry designed to stem rising malpractice insurance 
 
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costs and ensure the continued availability of malpractice insurance to Maine 
health care providers and practitioners.”  Id.  
 
[¶11]  Pursuant to the MHSA, a party bringing a claim for medical 
negligence, in contrast to a conventional tort claim, must comply with a number 
of distinct procedural requirements.  See 24 M.R.S. §§ 2853-2858, 2903(1).  
Most significantly for present purposes, the MHSA requires that, before the 
claim may be heard by a court, it must be presented to a prelitigation screening 
panel constituted of a judicial officer, an attorney, and a health care practitioner 
or provider.  Id. §§ 2852(2), 2853, 2903(1)(A)-(B).  The purpose of the panel 
proceeding is to allow the panel members to identify and separate meritorious 
claims from nonmeritorious claims and encourage the parties to achieve an 
early resolution of the litigation.  Id. §§ 2851(1), 2854; see also Sullivan v. 
Johnson, 628 A.2d 653, 656 (Me. 1993).  Additionally, pursuant to the MHSA, the 
notice of claim for professional negligence, the proceedings before the panel, 
and the panel’s final determinations are generally confidential.2  24 M.R.S. 
§§ 2853(1-A), 2857.   
                                         
2  The Legislature has created several narrowly circumscribed exceptions to the confidentiality 
that otherwise cloaks the proceedings before the panel and the panel’s findings.  All of those statutory 
exceptions are limited to public disclosure of that information under certain circumstances during a 
subsequent court action involving the same claim.  See 24 M.R.S. § 2857(1) (2018).    
 
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[¶12]  Spectrum asserts that it will irretrievably lose the rights and 
protections provided by the MHSA if it is denied appellate review of an order 
concluding that the claim is not subject to the MHSA.  We agree.  If a trial court 
were to erroneously deny a motion to dismiss a claim that the plaintiff has 
framed as an ordinary tort claim but is actually governed by the MHSA, the 
defendant would be deprived of “[t]he statutory mechanism for encouraging 
the settlement, withdrawal or dismissal of claims” for medical negligence.  
Sullivan, 628 A.2d at 656; cf. Morse Bros., Inc., 2001 ME 70, ¶ 15, 772 A.2d 842 
(stating that the anti-SLAPP special motion to dismiss is “a statutory creature 
designed to protect certain defendants from meritless litigation” and that 
“[p]recluding the moving party from appealing a decision on the motion would 
result in continued litigation, which is the precise harm that the statute seeks 
to prevent”).   
[¶13]  The confidential nature of the pre-suit proceedings for a claim 
governed by the MHSA is also at stake.  See 24 M.R.S. §§ 2853(1-A), 2857.  In 
other settings, we have concluded that a court order either requiring or 
allowing for the release of allegedly confidential information is immediately 
reviewable because the issue is within the purview of the death knell exception.  
See Fitch v. Doe, 2005 ME 39, ¶ 10, 869 A.2d 722 (concluding that an order 
 
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compelling the disclosure of an anonymous internet user’s identity is 
immediately reviewable, and stating that the “denial of the opportunity to 
appeal would make a later appeal moot, because the information at issue would 
already have been released”); see also Copp v. Liberty, 2003 ME 43, ¶ 6 n.2, 818 
A.2d 1050; Moffett, 400 A.2d at 343 n.8.  Because the defendant’s right to 
confidentiality would be irreparably lost if a claim for professional negligence 
proceeded outside the MSHA framework, the death knell exception to the final 
judgment rule applies for this reason as well.3   
[¶14]  A conclusion that the death knell exception does not apply in these 
circumstances would inappropriately minimize the importance of many of the 
procedures established in the MHSA and the goals promoted by that 
legislation.4  Accordingly, we conclude that, pursuant to the death knell 
                                         
3  Because the allegations in Salerno’s complaint are already public, the death knell exception is 
not available to protect any right of confidentiality Spectrum would have as to that information.  See 
Fiber Materials, Inc. v. Subilia, 2009 ME 71, ¶¶ 10-11, 19, 27, 974 A.2d 918 (dismissing an 
interlocutory appeal from an order denying the defendant’s motion to strike allegedly privileged 
material from the complaint because “the information that [the defendant] asserts is privileged has 
already been revealed, and is already part of the record”).  Here, however, the confidentiality 
Spectrum seeks to protect extends to information beyond what Salerno has alleged in her complaint.  
For example, a motion for summary judgment filed later in the proceeding could reveal considerable 
factual information to the public—information that would remain confidential if presented in a panel 
setting. 
 
4  We note that the substantial rights that would be irreparably lost absent interlocutory review 
do not include the three-year period of limitations applicable to claims for medical negligence—a 
period that is shorter than for civil claims generally.  Compare 24 M.R.S. § 2902 (2018) with 14 M.R.S. 
§ 752 (2018).  As we have held, the denial of a motion to dismiss an action as time-barred is not 
subject to review on an interlocutory appeal.  Porrazzo v. Karofsky, 1998 ME 182, ¶ 5, 714 A.2d 826; 
see also Tornesello v. Tisdale, 2008 ME 84, ¶ 18, 948 A.2d 1244.  Accordingly, Spectrum’s assertion 
 
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exception, Spectrum’s challenge to the court’s denial of its motion to dismiss 
Salerno’s complaint is cognizable on this interlocutory appeal.  
[¶15]  We now turn to the merits of the parties’ arguments. 
B. 
Spectrum’s Motion to Dismiss Salerno’s Complaint 
 
[¶16]  “On a motion to dismiss, facts are not adjudicated, but rather there 
is an evaluation of the allegations in the complaint in relation to any cause of 
action that may reasonably be inferred from the complaint.”  Saunders v. Tisher, 
2006 ME 94, ¶ 8, 902 A.2d 830.  “We examine the complaint in the light most 
favorable to the plaintiff to determine whether it sets forth elements of a cause 
of action or alleges facts that would entitle the plaintiff to relief pursuant to 
some legal theory.”  Id. (alterations omitted) (quotation marks omitted).   
 
[¶17]  Spectrum asserts that, although Salerno framed her claim as one 
for premises liability, her allegations actually constitute an action for 
professional negligence as that term is defined in the MHSA and thus must be 
brought pursuant to that Act’s provisions.  We disagree.  
 
[¶18]  The MHSA defines an “[a]ction for professional negligence” as 
any action for damages for injury or death against any health care 
provider, its agents or employees, or health care practitioner, his 
agents or employees, whether based upon tort or breach of 
                                         
that Salerno’s claim is barred by the three-year limitation period applicable to claims of professional 
negligence does not, by itself, allow an interlocutory appeal under the death knell exception.   
 
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contract or otherwise, arising out of the provision or failure to 
provide health care services.   
 
24 M.R.S. § 2502(6) (emphasis added).  Although we have described the MHSA 
as “broadly worded and all-encompassing,” Saunders, 2006 ME 94, ¶ 9, 902 
A.2d 830, and as “fully occupy[ing] the field of claims brought against health 
care providers,” Brand v. Seider, 1997 ME 176, ¶ 4, 697 A.2d 846 (quotation 
marks omitted), the statutory definition of “an action for professional 
negligence” contains several clear and distinct elements, see D.S. v. Spurwink 
Servs., Inc., 2013 ME 31, ¶¶ 21, 24, 65 A.3d 1196 (declining to expand the 
MHSA’s definition of “health care provider” against which an action for 
professional negligence may be brought pursuant to the MHSA).  One of those 
elements is that the claim must “aris[e] out of the provision or failure to provide 
health care services.”  24 M.R.S. § 2502(6). 
 
[¶19]  As described in her complaint, Salerno’s use of Spectrum’s locker 
room to change clothes after water therapy—without more—simply does not 
amount to the provision of health care services.  Although Salerno was present 
in the building for purposes of medical rehabilitation, she sustained her injuries 
because Spectrum was allegedly negligent by allowing a rubber mat to be left 
in the wrong place in the locker room—a circumstance unrelated to the 
provision of health care.  See Winona Mem’l Found. of Indianapolis v. Lomax, 465 
 
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N.E.2d 731, 732, 742 (Ind. Ct. App. 1984) (concluding that a claim, brought by a 
plaintiff who tripped and fell on her way from a dressing room to a physical 
therapy pool, was properly brought as a premises liability claim, and was not 
within the purview of that state’s Medical Malpractice Act); Zobac v. Se. Hosp. 
Dist. of Palm Beach Cty., 382 So. 2d 829, 830-31 (Fla. Dist. Ct. App. 1980) 
(concluding that a claim, brought by a patient alleging that he slipped and fell 
in water left on the floor of a hospital, was not required to be brought pursuant 
to the Florida Medical Liability Mediation Act).   
 
[¶20]  Consequently, Salerno’s claim that she slipped and fell while using 
Spectrum’s locker room is not within the ambit of the MHSA, and the court did 
not err by denying Spectrum’s motion to dismiss her complaint. 
The entry is: 
Order affirmed.  
 
 
 
 
 
 
 
 
Jonathan W. Brogan, Esq., Norman, Hanson & DeTroy, LLC, Portland, for 
appellant Spectrum Medical Group, P.A. 
 
Richard R. Regan, Esq., Moncure & Barnicle, Topsham, for appellee Ann Salerno 
 
 
York County Superior Court docket number CV-2017-269 
FOR CLERK REFERENCE ONLY