Case Title: Dehn v. Edgecombe

Citation: 384 Md. 606

Docket Number: 117/03

State: maryland

Court: Maryland Supreme Court

Date: 2005-01-14T00:00:00Z

Document:
In the Circuit Court for Prince George’s County
Case No. CAL 00-11627
IN THE COURT OF APPEALS
OF MARYLAND
No. 117
September Term, 2003
JAMES W. DEHN et ux.
v.
GLENN R. EDGECOMBE et al.
Bell, C.J.
Raker
Wilner
Cathell
Harrell
Battaglia
Eldridge, John C. 
  (Retired, specially assigned),
JJ.
Opinion by Raker, J.
Eldridge, J., joins in the judgment only 
Filed:   January 14, 2005
The principal question before this Court is whether Maryland recognizes an
independent cause of action in a patient’s wife against a doctor who acted negligently while
treating her husband but who had no relationship or direct interaction with the wife.  We
shall hold that petitioners do not have an independent cause of action against respondents
based upon  respondents’ alleged medical malpractice. 
I.
On May 11, 2000, Corinne Dehn and James Dehn filed in the Circuit Court for Prince
George’s County a medical malpractice action against Glenn Edgecombe, M.D., et. al.,
alleging that Dr. Edgecombe was negligent in providing post-operative care following Mr.
Dehn’s vasectomy. 
The case proceeded to trial before a jury.  The court dismissed all of Mrs. Dehn’s claims
at the close of the plaintiffs’ case.  The jury returned a verdict in favor of Mr. Dehn on the
issue of negligence, but in favor of Dr. Edgecombe on the issue of contributory negligence.
The court entered judgment in favor of Dr. Edgecombe and the Dehns noted a timely appeal
to the Court of Special Appeals.  That court affirmed, 152 Md. App. 657, 834 A.2d 146 (2003),
and we granted the Dehns’s Petition for Writ of Certiorari.  379 Md. 224, 841 A.2d 339 (2004).
A. Factual Background
We recount the facts as set out in the opinion of the Court of Special Appeals.
“At some time during 1994, when Mrs. Dehn was pregnant with
the couple's second child, the Dehns decided not to have any more
children.  To that end, they decided that Mr. Dehn should undergo
a vasectomy.  Mr. Dehn discussed his desire with Dr. Edgecombe,
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his family practice doctor.  Because Dr. Edgecombe was not
qualified to perform a vasectomy, he referred Mr. Dehn to a
surgeon, Dr. Samuel F. Mazella, who ultimately performed the
vasectomy on October 24, 1995.  There is no issue with respect to
the referral to Dr. Mazella or with respect to the vasectomy itself.
Nor is there any issue with respect to the post-operative care,
including post-operative advice, rendered by Dr. Mazella.  Dr.
Mazella expressly warned Mr. Dehn that the procedure might not
be effective and that Mr. Dehn might still be able to father a child.
To best insure against an unwanted pregnancy, Dr. Mazella
instructed Mr. Dehn 1) that he was not to have unprotected sexual
relations for six months and 2) that, during that time, he was to
have at least twenty ejaculations.  Dr. Mazella further provided
Mr. Dehn with three prescriptions for semen analyses.  He
instructed Mr. Dehn to have the first semen analysis done after
twenty ejaculations, and then to have the remaining two semen
analyses completed at some time during the remainder of the
initial six month period.  The results of those tests were to be sent
to Dr. Mazella's office.  Only if and when the third analysis
proved negative for sperm was the vasectomy to be considered to
be a successful birth control measure.  Dr. Mazella further
expressly instructed Mr. Dehn to contact him, Dr. Mazella, if he
had any concerns or problems during the post-operative period.
The evidence abundantly showed that Mr. Dehn negligently failed
to follow Dr. Mazella's instructions.  He never used the three
prescriptions for semen analysis, because, he claimed, they were
“vague” and they did not give him specific directions as to a
laboratory, a date, or a location for the sperm count test.  Mr.
Dehn acknowledged that one reason he did not follow instructions
was because he speculated that his health plan would probably not
pay for the tests.  Obviously, no sperm test results were ever sent
by Mr. Dehn to Dr. Mazella's office.
Mr. Dehn testified that he was not aware that three semen tests
were required.  At one point, he stated that he thought the tests
were merely a “follow-up” after the passage of six months and
twenty ejaculations, without pointing out the significance of that
conclusion.  Mr. Dehn acknowledged that, notwithstanding the
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instructions to contact Dr. Mazella about any questions or
concerns, he never again contacted Dr. Mazella.  Mr. and Mrs.
Dehn engaged in unprotected sexual relations in December of
1996, at which time she conceived the child whose unwanted birth
is the object of the present suit.
All of the controversy swirls about the nature of one or more
conversations between Mr. Dehn and Dr. Edgecombe during the
period between the performance of the vasectomy in October of
1995 and the onset of Mrs. Dehn's pregnancy in December of
1996.  During that time, Mr. Dehn saw Dr. Edgecombe, his
primary care provider, on at least several occasions for medical
matters unrelated to the vasectomy.
Dr. Edgecombe testified that it was not until July 8, 1996, eight
months after the vasectomy, that he even learned, in the course of
a visit for an unrelated matter, that the vasectomy had, indeed,
been performed on Mr. Dehn.  He stated that it was standard
practice for only the specialist surgeon who performed the
operation to handle all aspects of post-operative care, including
the monitoring of semen analyses.  He testified that on a single
occasion, the visit of July 8, 1996, Mr. Dehn raised with him the
subject of a semen analysis and that the subject came up in a
casual and offhand manner as they were leaving the office.
‘I had seen Mr. Dehn for a medically related topic.
We were done.  We were leaving the room and he
said, “Oh, by the way, Doctor, I need a semen
analysis.”  [It] was highly unusual.  No patient has
ever asked me that before.  Again, we were not in
the room, we were in the hall leaving.
‘The patient said to me, “Dr. Mazella never asked
or wanted to get a semen analysis.”  That was
unusual, and I told Mr. Dehn that I [had] had a
vasectomy in the past and my urologist had wanted
to get a semen analysis at three months after the
vasectomy or after 13 ejaculations.  At that point it
was almost nine months past the point where this
would have routinely been done.
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‘I told Mr. Dehn also [that] it takes at least 13
ejaculations for the vas deferens, the sperm duct, to
be emptied after a successful vasectomy.  He told
me that he had over twenty protected ejaculations.
I also told Mr. Dehn in the hall that I had not heard
of a vasectomy failing.  Based on what he told me,
that it was now six months after the fact when they
are routinely done, and that he had twenty protected
ejaculations, I’d assume that the surgeon had done
the procedure correctly.
‘He also seemed to indicate that the surgeon had
discharged him a long time previously and, based
on that, I said “I guess you don't need to have a
semen analysis.  It should have been done at three
months.”’
Dr. Edgecombe further testified that if Mr. Dehn had ever told
him that he had not had a single semen analysis test and had not
been discharged by Dr. Mazella, he would have sent Mr. Dehn
back to Dr. Mazella.  Dr. Edgecombe presented the expert opinion
of Dr. Boyle, a family practitioner, that because of the referral of
Mr. Dehn to Dr. Mazella, 1) there was no doctor-patient
relationship between Dr. Edgecombe and Mr. Dehn as to the
vasectomy and the post-operative care, 2) the patient had the
responsibility to follow the instructions of the specialist, and 3)
the referring physician could assume that such instructions were
followed.
Mr. Dehn, by way of stark contrast, testified that he had expressly
asked Dr. Edgecombe for ‘a referral for a semen analysis’ on three
separate occasions.  The first was on May 24, 1996, when Mr.
Dehn told Dr. Edgecombe that six months had passed since his
vasectomy, that he had had twenty ejaculations, and that he
needed a semen analysis to make certain that he was sterile.  Dr.
Edgecombe, however, reassured Mr. Dehn that there was no need
for a semen analysis and that there was no risk of impregnating his
wife. Mr. Dehn informed his wife about what Dr. Edgecombe had
said, but she still wanted to wait for a semen analysis before
engaging in unprotected sexual relations.
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Accordingly, Mr. Dehn again raised the subject with Dr.
Edgecombe on the occasion of his next medical appointment on
July 9.  He again asked Dr. Edgecombe for a referral for a semen
analysis and was again told that there was no need for one. Mrs.
Dehn, however, still insisted on waiting for a semen analysis
before having unprotected sexual relations.
Mr. Dehn, according to his testimony, brought the subject up with
Dr. Edgecombe on yet a third occasion on November 13, 1996.
According to his testimony, Dr. Edgecombe replied:
‘Jimmy, personally I had a vasectomy seven years
ago.  I didn't have a sperm count done.  Me and my
wife [sic] have practiced regular relations.  You're
not going to get your wife pregnant.  Will you go
home, [and] tell your wife I personally assure her
you cannot father any children.’
Dr. Edgecombe, on the other hand, denied that he had even seen
Mr. Dehn on November 13, for any reason.”
152 Md. App. at 663-67, 834 A.2d at 149-151.
B.  The Trial
Prior to trial, Dr. Edgecombe moved in limine, seeking to exclude any reference to Mr.
Dehn’s pre-existing medical condition as it related to his reasons for seeking a vasectomy.  The
defendants also sought to exclude any reference to any purported conversation by Dr.
Edgecombe suggesting that Mrs. Dehn had been impregnated by a man other than her husband.
Counsel argued that the probative value of this information was outweighed by the prejudicial
effect it would have on the jury.  In addition, defendants argued that there was no medical
testimony that Mr. Dehn’s life would be shortened for any reason.  The trial court granted the
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motion, ruling that the decrease in life expectancy and related matters were not relevant, and
more prejudicial than probative.
Trial commenced before a jury in July 2002 in the Circuit Court for Prince George’s
County.  Petitioners’ theory was that “the negligence in failing to provide a referral for semen
analysis is the fault of Dr. Edgecombe, and the cost of raising this child should be borne by the
party who was negligent.”  At the close of petitioners’ case, Dr. Edgecombe moved for
judgment in his favor.  As we have indicated, the Circuit Court granted the motion with respect
to Mrs. Dehn, dismissing all her claims, but allowed Mr. Dehn’s claims to proceed.  The jury
found that: (a) Dr. Edgecombe was negligent by his failure to provide adequate post-operative
care to Mr. Dehn following his vasectomy, and (b) Mr. Dehn was contributorily negligent by
his failure to follow the instructions of Dr. Mazella who performed the vasectomy.  Based on
the jury finding of contributory negligence, the court entered judgment on behalf of Dr.
Edgecombe.
Before the Court of Special Appeals, the Dehns argued that the Circuit Court’s
dismissal of Mrs. Dehn’s claims against Dr. Edgecombe was legal error.  The court disagreed
with the Dehns and held that because Mrs. Dehn had never been a patient of Dr. Edgecombe,
he did not owe her the duty of care arising out of a doctor-patient relationship.  Thus, she could
assert no cognizable claim of negligence against the doctor.  The court rejected the argument
that, even in the absence of a doctor-patient relationship, Dr. Edgecombe owed her a duty of
care by virtue of her position as the spouse of Mr. Dehn.  The court explained that any claims
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for damages Mrs. Dehn might have had in the absence of a doctor-patient relationship were
“derivative” of her husband’s claims, meaning that she could not raise an independent cause
of action against the doctor, and that any viable claim she might have had was dependent on
the successful recovery by Mr. Dehn on his “primary” negligence action.  As it happens, Mr.
Dehn’s claim of negligence was not viable because the jury found him to be contributorily
negligent, which, in Maryland, is a complete bar to any recovery by a plaintiff.  See Harrison
v. Montgomery County Bd. of Educ., 295 Md. 442, 456 A.2d 894 (1983).  Under the holding
of the Court of Special Appeals, Mrs. Dehn, like her husband, could recover no damages from
Dr. Edgecombe.
The Dehns petitioned this Court for a Writ of Certiorari, presenting the following
questions for our consideration:
“I.  In negligent sterilization cases should the doctor-patient
relationship be recognized to permit a duty between the doctor and
patient’s spouse when as a result of the negligent sterilization, the
obvious and natural consequence of the malpractice would be that
the wife will become pregnant and give birth?  If so, would this
cause of action be independent or derivative of the patient?
“II.  Whether the trial court was properly able to exercise its
discretion in forbidding the introduction of extremely probative
and critical evidence related to the patient’s genetic reason for the
sterilization, when the trial judge: (1) failed to properly consider
the use of this evidence as it pertains to the case of Jones v.
Malinowski, [299 Md. 257, 473 A.2d 429 (1984)], and (2)
misconstrued the proposition that the evidence was being offered
for while intruding on the jury’s province of determining the
credibility of witnesses?
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“III.  Whether the trial judge erred by ruling that Mr. Dehn could
not recover any nonpecuniary damages even though such damages
are normally recoverable in negligence actions in Maryland?” 
II.
Petitioners argue in this Court that Mrs. Dehn should be permitted to bring an
independent cause of action despite her lack of a doctor-patient relationship with Dr.
Edgecombe.  Petitioners rely primarily on the seminal case of Jones v. Malinowski, 299 Md.
257, 473 A.2d 429 (1984), in which this Court held that the parents who conceived an
unwanted but healthy child because of a doctor’s negligently performed sterilization on the
wife were permitted to receive damages for child-rearing costs, offset by the benefits the
parents derived from the child’s aid, society, and comfort.  Id. at 270, 473 A.2d at 435.
Although  the Court’s holding in that case did not speak to the precise issue here, petitioners
base almost their entire argument on language in Jones, which refers to the recipients of the
damages of child-rearing costs as the “parents,” not as the single parent who underwent the
negligent sterilization.  They reason that because the Jones Court recognized that both parents
suffer harm and costs resulting from that surgery, it is implicit in the holding that each parent
has his or her own independent negligence action against the doctor.  Petitioners also contend
that an independent cause of action by the wife accrues because it is eminently foreseeable that
a doctor’s post-operative advice regarding a vasectomy to a husband could have serious effects
on his wife.
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Respondents’ primary argument is that there was no error, and if there was, it was
harmless.  Respondents maintain that any error alleged by petitioners is not prejudicial because
the jury found that Dr. Edgecombe was negligent.  Petitioners cannot complain because the
relevant part of the verdict was in their favor.  On the substantive issue, respondents counter
that the traditional rule in Maryland is that there can be no cause of action in negligence
without there first being a duty on the part of the alleged tortfeasor.  A duty, in turn, requires
that there be a relationship between Dr. Edgecombe and Mrs. Dehn.  No such relationship
exists, and therefore there was no duty on the part of Dr. Edgecombe.  Respondents disagree
with the contention that the pregnancy effected by the doctor’s negligent acts was foreseeable:
Dr. Edgecombe was not the surgeon who performed the vasectomy, nor were his conversations
with Mr. Dehn in the context of separate post-operative care for the vasectomy but rather for
an entirely unrelated medical matter.  Thus, those conversations, after which Mr. Dehn decided
to forgo the semen analyses altogether, could not reasonably be deemed the foreseeable causes
of the pregnancy of a person whom the doctor had never met.
1 In petitioners’ complaint, as amended, Count I alleged negligence on the part of Dr.
Edgecombe because he negligently failed to provide Mr. Dehn with a referral for a sperm
count analysis after the performance of the vasectomy.  Count II alleged negligence on the
part of Dr. Samuel F. Mazella, the surgeon who performed the vasectomy, for failing to
provide for a sperm count analysis after the performance of a vasectomy.  Count III alleged
wrongful pregnancy against Drs. Mazella and Edgecombe.  Count IV alleged breach of
contract.  Count V alleged petitioners’ loss of consortium.  Counts VI and VII alleged
vicarious liability of Carefirst of Maryland and Capital Care, respectively, two health
maintenance organizations.  Dr. Mazella and the health care providers, Carefirst and Capital
Care, are not parties to this appeal.
An action for “wrongful pregnancy” has been defined as a “suit filed by a parent for
proximate damages arising from the birth of a child subsequent to a doctor's failure to
properly perform a sterilization procedure.”  Johnson v. University Hosp. of Cleveland, 540
N.E.2d 1370 (Ohio 1989) (citing Jones v. Malinowski, 299 Md. 257, 473 A.2d 429 (1984)).
Wrongful pregnancy actions typically involve a healthy child.  See Bruggeman v. Schimke,
718 P.2d 635, 638 (Kan. 1986).  In Maryland, a wrongful pregnancy action is nothing more
than an action in negligence and is decided properly by applying the same legal analysis
employed in any medical negligence claim.
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III.
The cause of action Mrs. Dehn wishes to bring against Dr. Edgecombe sounds in
negligence.1  Medical malpractice “is predicated upon the failure to exercise requisite medical
skill and, being tortious in nature, general rules of negligence usually apply in determining
liability.”  Benson v. Mays, 245 Md. 632, 636, 227 A.2d 220, 223 (1967).  This understanding
is not changed by the fact that the specific conduct constituting the medical malpractice at issue
is negligent sterilization.  As we explained in Jones v. Malinowski, negligence in the
performance of a sterilization procedure is “a cause of action in tort based upon traditional
medical malpractice principles.”  299 Md. at 263, 473 A.2d at 432.  We said that these
“fundamental principles” of a tort action for negligence are “manifestly applicable to a medical
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malpractice action in Maryland involving . . . a suit by parents for money damages from a
physician for the negligent performance of a sterilization operation.”  Id. at 269, 473 A.2d at
435.  By treating a negligent sterilization case like any other negligence tort, we concluded that
damages flowing from negligent sterilization should be assessed using traditional negligence
principles.  We held in Jones that there could be compensable injury to parents when a child
is born as a result of medical negligence, and that the measure of damages included “child
rearing costs to the age of the child’s majority, offset by the benefits derived by the parents
from the child’s aid, society and comfort.”  Id. at 270, 473 A.2d at 435.  Thus, Mrs. Dehn’s
claim of negligent sterilization, if there is one, is to be treated like any other medical
malpractice tort, that is, as a traditional negligence claim.  Cf. Reed v. Campagnolo, 332 Md.
226, 232, 630 A.2d 1145, 1148 (1993) (applying same “traditional medical malpractice
principles for negligence” as in Jones to an action alleging so-called “wrongful birth,” which
alleges that the negligence of a physician deprived his patient of the opportunity to terminate
a pregnancy that would likely result in a child born with severe birth defects).  
In order to state a claim in negligence, the plaintiff must allege and prove facts
demonstrating “(1) that the defendant was under a duty to protect the plaintiff from injury,  (2)
that the defendant breached that duty, (3) that the plaintiff suffered actual injury or loss, and
(4) that the loss or injury proximately resulted from the defendant’s breach of the duty.”
Horridge v. Social Services, 382 Md. 170, 182, 854 A.2d 1232, 1238 (2004); Green v. North
Arundel Hospital, 366 Md. 597, 607, 785 A.2d 361, 367 (2001).  Our focus is on the first
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element, a legally cognizable duty owed by Dr. Edgecombe to Mrs. Dehn, for without a duty,
no action in negligence will lie. 
Duty, in negligence, is “an obligation, to which the law will give recognition and effect,
to conform to a particular standard of conduct toward another.”  Prosser and Keeton on the
Law of Torts, § 53 at 356 (5th ed. 1984).  It is based upon a relationship between the actor and
the injured person.  The issue of duty is one for the court as a matter of law.  See Hemmings
v. Pelham Wood, 375 Md. 522, 536, 826 A.2d 443, 451 (2003); Valentine v. On Target, 353
Md. 544, 551, 727 A.2d 947, 950 (1999).
It is the general rule that recovery for malpractice against a physician is allowed only
where there is a relationship between the doctor and patient.  See, e.g., Eid v. Duke, 373 Md.
2, 16, 816 A.2d 844, 852 (2003); Dingle v. Belin, 358 Md. 354, 367, 749 A.2d 157, 164
(2000); Hoover v. Williamson, 236 Md. 250, 253, 203 A.2d 861, 863 (1964); Lemon v. Stewart,
111 Md. App. 511, 521, 682 A.2d 1117, 1181 (1996).  See also Rigelhaupt, What Constitutes
Physician-Patient Relationship for Malpractice Purposes, 17 A.L.R.4th 132 (2005).  This
relationship may be established by contract, express or implied, although creation of the
relationship does not require the formalities of a contract, and the fact that a physician does not
deal directly with a patient does not necessarily preclude the existence of a physician-patient
relationship.  What is important, however, is that the relationship is a consensual one, and
when no prior relationship exists, the physician must take some action to treat the person
before the physician-patient relationship can be established.
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There are exceptions to this rule.  For example, when a physician undertakes to act
gratuitously or in an emergency situation, a duty may be created, see Hoover v. Williamson,
236 Md. 250, 253, 203 A.2d 861, 863 (1964), but such exceptions are rare, particularly when
the doctor never provided any treatment to the person alleging negligence.  In Homer v. Long,
90 Md. App. 1, 599 A.2d 1193 (1992), a husband sued his wife’s psychiatrist for damages
resulting from the psychiatrist’s affair with his wife, even though the husband was never a
patient of the psychiatrist.  The husband had retained the psychiatrist to treat his wife and to
provide “appropriate counseling and psychiatric treatment” for her.  He gave to the doctor
“sensitive and confidential information” to aid in the treatment.  The psychiatrist responded
by using that information to commence a sexual relationship with the wife, which led to the
end of her marriage.  The court held that the husband’s negligence claim suffered from fatal
deficiencies—primarily a failure to allege a duty that the law is prepared to recognize.  Id. at
10, 599 A.2d at 1197.  Judge Wilner, then Chief Judge of the Court of Special Appeals, and
currently a judge on this Court, wrote for the panel that “the normal duty that a doctor has to
act in conformance with accepted standards of medical practice” did not apply to the husband.
Id. at 10, 599 A.2d at 1197.
In Homer, the court noted that some courts have recognized a duty of a physician to a
non-patient in limited circumstances, such as when the patient has a communicable disease that
puts another person at risk.  Id.  In Lemon v. Stewart, 111 Md. App. 511, 682 A.2d 1177
(1996), the plaintiffs sued the health care provider of a patient to whom they were related
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because the provider failed to inform them of the patient’s HIV-positive test results.  Judge
Wilner, again for the Court of Special Appeals, reiterated the general rule that “[t]he common
law duty of care owed by a health care provider to diagnose, evaluate, and treat its patient
ordinarily flows only to the patient, not to third parties.  Thus, it has often been said that a
malpractice action lies only where a health care provider-patient relationship exists and there
has been a breach of a professional duty owing to the patient.”  Id. at 521, 682 A.2d at 1181.
The court held that under the circumstances presented, no duty existed on the part of the health
care provider to disclose test results to the plaintiffs, noting that to impose such a duty was not
only impractical but improper, based upon the public policy that the patient’s privacy rights
would be violated.
Homer and Lemon teach that although the common law does not foreclose the
possibility of imposing a duty of care in the absence of a doctor-patient relationship to a third
party who never received treatment from the doctor, it will not do so except under
extraordinary circumstances.  In Homer, the husband of the patient-wife not only hired the
physician to treat his wife but also gave him confidential, personal information on their
marriage.  But even so, the Court of Special Appeals was unable to discern a doctor-patient
relationship sufficient to impose a medical malpractice duty of care on the psychiatrist with
respect to the husband.  Homer, 90 Md. App. at 10, 599 A.2d at 1197.  In Lemon, even where
there existed the potential for transmittal of a fatal virus, the court refused to impose a duty of
care on the physicians to notify third parties, even relatives.
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We turn to the threshold question in this case: whether there existed a duty flowing from
Dr. Edgecombe to Mrs. Dehn, because if there was no duty, her negligence action will not lie.
Mrs. Dehn alleges that a duty to her was breached when Dr. Edgecombe negligently failed to
provide Mr. Dehn with the minimally acceptable level of medical care, by unreasonably
refusing to provide a referral for a sperm count after the performance of a vasectomy, despite
the requests of Mr. Dehn.  We conclude there was no duty.  Judge Moylan, writing for the
panel in the Court of Special Appeals, pointed out the absence of any physician-patient
relationship between Mrs. Dehn and the doctor, stating as follows:
“There was no direct doctor-patient relationship between Dr.
Edgecombe and Mrs. Dehn.  The two of them had never met or
spoken to each other until the day of trial.  Dr. Edgecombe was
Mr. Dehn's primary health care provider, not Mrs. Dehn's. Mr.
Dehn, not Mrs. Dehn, was in the health care program that
involved Dr. Edgecombe.  The evidence was, moreover, that on
the three post-vasectomy occasions when Dr. Edgecombe was
allegedly negligent, Mr. Dehn was not even visiting him to discuss
post-operative care relating to the vasectomy but was visiting him,
without Mrs. Dehn, for other and unrelated medical purposes.  If
a duty of care owed by Dr. Edgecombe to Mrs. Dehn is to be
found, therefore, its source must be somewhere other than in a
doctor-patient relationship per se between the two of them.”
152 Md. App. at 681, 834 A.2d at 159-60.
Petitioners, however, would prefer that we circumvent the duty of care analysis
altogether and simply rely on what they consider to be the implicit holding of Jones v.
Malinkowski.  Petitioners argue that the question of whether Mrs. Dehn has a cause of action
against the doctor in her own right has been answered by our holding in Jones, which used
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language that indicated that the “parents,” not the single parent who underwent the
sterilization, were entitled to recover child-rearing costs.  We disagree.  
The question of whether a doctor owes a duty to a spouse of the patient, independent
of the duty to the patient who underwent sterilization, was never presented to the Court in
Jones.  In that case, we granted certiorari to consider a single issue of first impression in this
State, raised in the joint petition of the parties, namely: “Where a negligently performed
sterilization resulted in the birth of a healthy child, did the trial court err in its charge that the
jury could award damages for the expenses of raising the unplanned child during minority
reduced by value of the benefits conferred upon the parents by having the child?”  299 Md. at
259, 473 A.2d at 430.  There was no issue of a dismissed spouse as a party; nor was the issue
of a duty by the physician to the spouse who did not undergo sterilization ever raised.  In fact,
disposition of that question would have made no difference in the case because there was no
contributory negligence on the part of one of the parties, as in the case sub judice.  In this
regard, we completely agree with Judge Moylan’s analysis in the Court of Special Appeals:
“In Jones v. Malinowski, to be sure, there were two plaintiffs,
husband and wife. The wife suffered a flawed sterilization
operation.  The husband was indirectly involved as her spouse.  In
Jones v. Malinowski, however, the claim of neither plaintiff was,
as here, dismissed from the suit.  There was, moreover, no verdict,
as in this case, of contributory negligence against one of the
plaintiffs.  There was, therefore, no issue in Jones v. Malinowski
that involved any difference in the litigational postures of the
respective plaintiffs.  Their only role in that case was as an  entity.
It made no difference to the outcome of that case whether there
was one proper plaintiff or two.  Consequently, the Court did not
pay any attention to what was, in that context, a non-issue.
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“Most assuredly, Jones v. Malinowski did not hold, as Mrs. Dehn
now maintains, that in a suit for wrongful birth based on a
doctor’s negligence each parent has an independent right to sue
the defendant-doctor regardless of whether that parent had ever
been in a doctor-patient relationship with the defendant or not.  If
there was a duty of care owed by Dr. Edgecombe to Mrs. Dehn,
its source must be sought by some modality other than attempting
to read between the lines of Jones v. Malinowski.  The only
significance of the silence of Jones v. Malinowski is that although
it did not affirm the existence of an extended duty of care to the
patient’s spouse, neither did it deny it.  For the purposes of our
present analysis, the question remained open.”
152 Md. App. at 686, 834 A.2d at 162-63.
Petitioners raise several other arguments in favor of imposing such a duty.  First,
petitioners maintain that Dr. Edgecombe owed Mrs. Dehn a duty to act within the relevant
standard of post-operative care for Mr. Dehn’s vasectomy because, even though she was not
a direct patient,  it was foreseeable that negligence in the care of a vasectomy will result in the
wife’s pregnancy.  Second, that the birth of a child has legal consequences for both parents,
since both parents have a statutory and common law duty to provide for the needs of their
children.  See Md. Code (2004 Repl. Vol.), § 5-203(b) of the Family Law Article.  Third, that
where, as here, the negligent sterilization is a vasectomy on the husband, the physical
consequences of a pregnancy, and of the physician’s negligence, obviously are more serious
for the wife than for the husband who was the patient.
First, mere foreseeability of harm or injury is insufficient to create a legally cognizable
special relationship giving rise to a legal duty to prevent harm.  We recently discussed the
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nature of duty and foreseeability in Patton v. USA Rugby, 381 Md. 627, 851 A.2d 566 (2004).
Judge Harrell, writing for the Court, noted as follows:
“Where the failure to exercise due care creates risks of personal
injury, ‘the principal determinant of duty becomes foreseeability.’
The foreseeability test ‘is simply intended to reflect current
societal standards with respect to an acceptable nexus between the
negligent act and the ensuing harm.’  In determining whether a
duty exists, ‘it is important to consider the policy reasons
supporting a cause of action in negligence.   The purpose is to
discourage or encourage specific types of behavior by one party
to the benefit of another party.’  ‘While foreseeability is often
considered among the most important of these factors, its
existence alone does not suffice to establish a duty under
Maryland law.’”
Id. at 637, 851 A.2d at 571 (citations omitted).  In Ashburn v. Anne Arundel County, 306 Md.
617, 510 A.2d 1078 (1986), we noted:
“However, ‘foreseeability’ must not be confused with ‘duty.’  The
fact that a result may be foreseeable does not itself impose a duty
in negligence terms.  This principle is apparent in the acceptance
by most jurisdictions and by this Court of the general rule that
there is no duty to control a third person's conduct so as to prevent
personal harm to another, unless a ‘special relationship’ exists
either between the actor and the third person or between the actor
and the person injured.” 
Id. at 628, 510 A.2d at 1083 (1986).
As our cases have made clear, it is only in a limited number of cases where a special
relationship sufficient to impose a duty of care will be found in the absence of traditional tort
duty.  See Horridge v. Social Services, 382 Md. 170, 854 A.2d 1232 (2004); Remsburg v.
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Montgomery, 376 Md. 568, 831 A.2d 18 (2003); Muthukumarana v. Montgomery County, 370
Md. 447, 805 A.2d 372 (2002).  We believe this is not such a case.
 In this case, petitioners do not maintain that there exists a statutory basis for imposing
a duty, nor a contractual basis for imposing a duty.  Instead, they maintain that there exists a
special relationship based on the foreseeability of injury to M rs. Dehn. 
We find petitioners’ arguments unpersuasive.  In a discussion of the limitations courts
place upon an actor’s responsibility for the consequences of the actor’s conduct, Prosser &
Keeton set out the principle as follows: 
“As a practical matter, legal responsibility must be limited to those
causes which are so closely connected with the result and of such
significance that the law is justified in imposing liability.  Some
boundary must be set to liability for the consequences of any act,
upon the basis of some social idea of justice or policy.
“This limitation is to some extent associated with the nature and
degree of the connection in fact between the defendant's acts and
the events of which the plaintiff complains. Often to greater
extent, however, the legal limitation on the scope of liability is
associated with policy—with our more or less inadequately
expressed ideas of what justice demands.”
Prosser and Keeton on the Law of Torts, § 41 at 264 (5th ed. 1984).
Whatever arguments might exist for extending the duty of care to a spouse in some
other negligent sterilization case, the case sub judice is not the one for doing so.  Dr.
Edgecombe was not the physician who performed the vasectomy.  Any reasonable reliance
Mrs. Dehn might have placed in a doctor who performed the actual vasectomy on her husband
is attenuated by the fact that Dr. Edgecombe did not perform the vasectomy and was caring for
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her husband on an unrelated matter when he made his alleged negligent statements.  Moreover,
not only was there no direct doctor-patient relationship as a result of a contract, express or
implied, that Dr. Edgecombe would treat Mrs. Dehn with proper professional skill, but the two
never even met each other until the day of trial, nearly seven years after the vasectomy.  Dr.
Edgecombe did not claim to be giving Mr. Dehn post-operative care; in fact, that care was
explicitly undertaken by Dr. Mazella who performed the vasectomy and whose instructions Mr.
Dehn ignored.  
Nor are we willing to impose a legal duty on Dr. Edgecombe with regard to Mrs. Dehn
based simply on his alleged awareness that Mr. Dehn was married.  A duty of care does not
accrue purely by virtue of the marital status of the patient alone; some greater relational nexus
between doctor and patient’s spouse must be established, if it can be established at all, and here
it was not.  A duty of care to a non-patient is not one which Maryland law is prepared to
recognize under these circumstances.  The imposition of a common law duty upon Dr.
Edgecombe to the wife under these circumstances could expand traditional tort concepts
beyond manageable bounds.  The rationale for extending the duty would apply to all potential
sexual partners and expand the universe of potential plaintiffs.  All of the above rationales for
extending the duty of care apply with equal force to a non-spouse:  Unmarried as well as
married couples are bound by law to provide for their children, and the physical consequences
of childbirth from a negligent vasectomy remain the same regardless of whether the mother is
married or not.  Based on these rationales alone, a family practitioner who ostensibly provides
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after-care following a sterilization procedure performed by another physician would owe a duty
of care not just to the patient who underwent the operation but every sexual partner the patient
encounters after the operation—a possibility the law does not countenance.
IV.
Petitioners appeal from the evidentiary rulings pertaining to Mr. Dehn’s peripheral
artery disease; to separate referrals that Dr. Edgecombe gave to Mr. Dehn unrelated and several
years prior to the vasectomy; and to Dr. Edgecombe’s doubts about the paternity of Mrs.
Dehn’s child.  Had these “key” pieces of evidence been admitted by the trial court, argue
petitioners, the jury would not have found Mr. Dehn contributorily negligent.  Thus, we are
concerned here only with the impact the evidence might have had on the jury’s finding of
contributory negligence.
The trial court rulings were based upon a finding that the prejudicial value of the
evidence outweighed the probative effect.  In making this determination, “[t]he admissibility
of evidence, including rulings on its relevance, is left to the sound discretion of the trial court,
and absent a showing of abuse of that discretion, its rulings will not be disturbed on appeal.”
Farley v. Allstate Ins. Co., 355 Md. 34, 42, 733 A.2d 1014, 1018 (1999).  When the trial
court’s evidentiary rulings result from its determination that the relevance of certain evidence
is outweighed by its potential for prejudice, we review that determination for an abuse of
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discretion.  Bern-Shaw v. Baltimore, 377 Md. 277, 291, 833 A.2d 502, 510 (2003).  “Abuse
of discretion” has been described aptly as follows:
“‘Abuse of discretion’ is one of those very general, amorphous
terms that appellate courts use and apply with great frequency but
which they have defined in many different ways. . . . [A] ruling
reviewed under an abuse of discretion standard will not be
reversed simply because the appellate court would not have made
the same ruling.  The decision under consideration has to be well
removed from any center mark imagined by the reviewing court
and beyond the fringe of what that court deems minimally
acceptable.  That kind of distance can arise in a number of ways,
among which are that the ruling either does not logically follow
from the findings upon which it supposedly rests or has no
reasonable relationship to its announced objective.  That, we
think, is included within the notion of ‘untenable grounds,’
‘violative of fact and logic,’ and ‘against the logic and effect of
facts and inferences before the court.’”
North v. North, 102 Md. App. 1, 13-14, 648 A.2d 1025,1031-1032 (1994).
There was no such abuse here.  The trial court’s evidentiary rulings with respect to these
three categories were not violative of fact or logic or beyond the fringe of what is minimally
acceptable.  The trial court, whose “finger [is] on the pulse of the trial,” State v. Hawkins, 326
Md. 270, 278, 604 A.2d 489, 493 (1992), had a sound basis to decide, for example, that the
prejudicial value of evidence on Mr. Dehn’s arterial disease outweighed any probative value
it might have had; similarly, the trial court concluded, logically, that admitting evidence on Mr.
Dehn’s past referrals from Dr. Edgecombe regarding the arterial disease, not the vasectomy,
was simply another, more oblique opening into admitting evidence about the disease itself and
therefore was inconsistent with the ruling excluding evidence on the disease.  Finally, it was
2 Petitioners argued in their opposition to respondents’ motion in limine that Mr.
Dehn’s health and Dr. Edgecombe’s statements about paternity were “essential elements of
the damages caused to Plaintiffs in this case.”  Later, petitioners attempted  to argue that the
evidence on paternity should be allowed to rebut respondents’ argument that the statute of
limitations barred relief.  Petitioners also argued that the treatment for the peripheral artery
disease was “part and parcel” of the post-operative treatment of the vasectomy, serving to
show that Dr. Edgecombe acted negligently and that “it’s untrue that he would not have
focused on the need for a semen analysis to prevent further children.”  The closest petitioners
came to arguing this theory occurred when petitioners’ counsel attempted to elicit testimony
on the peripheral artery disease to undermine the credibility of respondents’ witnesses who,
according to counsel, attempted to convince the jury on the disputed fact that there was only
one occasion during which Dr. Edgecombe and Mr. Dehn discussed the need for a sperm
analysis.  Presumably, this information would have led the jury to believe Mr. Dehn that he
met with the doctor three times to request the semen analysis, which would, in turn, lead to
the conclusion that Mr. Dehn was non-negligent.  We agree with the trial court, especially
since the negligent acts of Mr. Dehn occurred with respect to the instructions of Dr. Mazella
(continued...)
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well within the discretion of the court to determine that Dr. Edgecombe’s erroneous statements
made post-pregnancy regarding the paternity of Mrs. Dehn’s child could be substantially
prejudicial against him and, in any event, had little, if any, bearing on the contributory
negligence of Mr. Dehn which occurred pre-pregnancy.
Petitioners’ theories on how the exclusion of this evidence had an accumulated effect
that would have negated the finding of Mr. Dehn’s contributory negligence—which consisted,
mainly, of Mr. Dehn’s failure to adhere to Dr. Mazella’s, not Dr. Edgecombe’s, orders—only
illustrate how very attenuated is the link of the evidence to Mr. Dehn’s conduct.  Indeed, we
note that none of these theories, which argue that the excluded evidence would have shown
that Mr. Dehn acted reasonably and non-negligently, were squarely presented to the trial court
by petitioners’ counsel who instead argued for admissibility on substantially different grounds.2
2(...continued)
and had nothing to do with the conversations with Dr. Edgecombe. 
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V.
The final question presented for our review deals with the availability of nonpecuniary
damages in this action.  Because Mr. Dehn’s recovery is barred by his contributory negligence,
he is not entitled to any damages, whether pecuniary or nonpecuniary, and thus we do not
address the question.
JUDGMENT OF THE COURT
O F  
S P E C I A L  
A P P E A LS
AFFIRMED.  COSTS TO BE
PAID BY PETITIONERS.
Judge Eldridge joins in the judgment only.