Case Title: Carrion v. Linzey

Citation: 342 Md. 266

Docket Number: 56/95

State: maryland

Court: Maryland Supreme Court

Date: 1996-04-10T00:00:00Z

Document:
IN THE COURT OF APPEALS OF MARYLAND
No. 56  
  September Term, 1995
___________________________________
TIMOTHY J. CARRION, ET AL.
v.
ROBERT P. LINZEY
___________________________________
Murphy, C.J.
Eldridge
Rodowsky
Chasanow
Karwacki
Bell
Raker
JJ.
___________________________________
Opinion by Karwacki, J.
___________________________________
-2-
      Filed:  April 10, 1996       
         
      Hereinafter, unless otherwise indicated, all statutory references are to
1
Md. Code (1974, 1995 Repl. Vol.) of the Courts & Judicial Proceedings Article.
We are once again asked to construe the statutory presumption
of correctness that attaches to the finding of a health claims
arbitration panel decision in a subsequent circuit court "judicial
review."  Maryland Code (1974, 1995 Repl. Vol.), § 3-2A-06 (d) of
the Courts & Judicial Proceedings Article.   Twice previously we
1
have interpreted this provision.  In Attorney General v. Johnson,
282 Md. 274, 385 A.2d 57 (1978), appeal dismissed, 439 U.S. 805, 99
S. Ct. 60, 58 L. Ed. 2d 97 (1978), we held that the statutory
presumption 
of 
correctness 
did 
not 
violate 
constitutional
guarantees of a fair trial.  In Newell v. Richards, 323 Md. 717,
594 A.2d 1152 (1991), we held that the presumption did not shift
the ultimate burden of proof of negligence from plaintiff to
defendant in the trial of a case where the panel's decision was
adverse to the defendant.  In the case sub judice we look again at
the statutory presumption of correctness, this time to explore what
a jury should be told about an arbitration panel's membership and
vote.  Implicit within this inquiry is a more fundamental question
about how a party, aggrieved by a decision of an arbitration panel,
-2-
      Claims against Dr. Lurie in his individual capacity were dismissed by the
2
chairperson of the Health Claims Arbitration panel.
may attack that decision to overcome the presumption of
correctness.
I.
This appeal arises out of Robert P. Linzey's claim of dental
malpractice against Dr. Timothy J. Carrion, Dr. Donald B. Lurie,2
and their employer, Donald B. Lurie, D.D.S., P.A. [hereinafter, the
appellants will be referred to collectively as "Carrion"].  On May
18, 1987, Carrion performed oral surgery on Linzey.  This
procedure, called a bilateral sagittal split osteotomy, was
intended to correct an "open bite" by moving Linzey's lower jaw
into proper alignment with his upper jaw.  As part of the
procedure, Carrion applied fixation devices to secure the lower jaw
during healing.  When the fixation devices were removed five weeks
later, all signs indicated that the surgery had been successful.
Two weeks later, however, a follow-up examination revealed that his
lower jaw was not properly healing, allowing the jaw to slip back
into its previous position.  Carrion then performed a second
operation to reposition the lower jaw.  
By November of 1987, unsatisfied with Carrion's care, Linzey
found a new orthodontist who performed a third surgery to correct
Linzey's "open bite."
-3-
In May of 1990, Linzey filed a claim of dental malpractice
with the Director of the Health Claims Arbitration Office in
accordance with the procedures set forth in the Health Claims
Arbitration ["HCA"] Act, § 3-2A-01, et seq.  An arbitration panel
was assembled which included John F. Burgan, Esq., panel chair, Dr.
Carl J. Oppenheim, a dentist, and Dr. Edward Beach, a Ph.D in
Education and the lay member of the panel.  On March 5, 1992, at
the conclusion of a four-day arbitration hearing, the panel found
Carrion liable for malpractice and awarded damages of $167,600.
Counsel for Carrion contacted the arbitration panel members,
and on March 21, 1992, procured an affidavit from Dr. Oppenheim who
swore that he had dissented from the decision of the panel.
Carrion then attempted to make use of the revisory power of the
panel chair, granted by § 3-2A-05, to have the panel's award
reflect the split decision.  Chairperson Burgan by order dated
April 17, 1992, declined to modify the award to reflect Dr.
Oppenheim's dissenting vote.  Carrion then filed an action to
reject the arbitration award in the Circuit Court for Baltimore
City, where the case was scheduled for a jury trial.
At the beginning of trial Carrion filed a motion in limine to
clarify what the jury could be told about the arbitration panel's
membership and decision.  At issue were three general facts:
1.
that the panel was composed of a lawyer,
a dentist, and a lay person;
-4-
2.
that the decision of a panel need not be
unanimous; and
3.
that the dentist member of the panel (Dr.
Oppenheim) had dissented.
Carrion would have preferred that all three of these facts be
brought to the jury's attention because he hoped that the jury
might tend to give less weight to a split decision than to a
unanimous decision, and because an impartial dentist's opinion
might be very persuasive in convincing the jury that Carrion had
not breached the standard of care.  Short of the jury being told
all three facts, Carrion hoped to avoid a circumstance in which the
jury would learn about the panel membership, but not learn that a
panel decision need not be unanimous and was not unanimous in this
case.  Carrion's concern was that the jurors, knowing that their
decision must be unanimous, would assume that the arbitration
panel's decision also had to be unanimous, and knowing the
composition of the panel, would conclude that the dentist-panel
member had found Carrion liable.  Carrion feared that this
erroneous conclusion would weigh heavily with the jury as the
panel-dentist would be perceived as an expert on dental care
offering an impartial opinion that Carrion was liable.
The trial judge ruled that evidence of the panel's membership
and vote would be inadmissible at trial and issued an order in
limine to exclude references to these facts.  "When counsel
remarked (prophetically) that the jury was going to wonder about
-5-
the composition of the panel, the trial judge responded, `And I am
going to tell them it is none of their business.'"  Linzey v.
Carrion, 103 Md. App. 116, 121, 652 A.2d 1154, 1156 (1995).
The case was tried on June 16-23, 1993, and the trial judge
described it as "a vigorously contested case, well-tried on both
sides . . . ."  Late in the proceedings, counsel for both parties
read into evidence portions of Linzey's testimony at the
arbitration panel hearing.  Linzey's counsel, who may have been
simply attempting to give the jury some context for the testimony,
mentioned that a question from the panel was asked by "Dr.
Oppenheim."  Counsel did not identify Dr. Oppenheim either as a
panel member or as a dentist.  After the jury was excused,
Carrion's counsel objected, but the trial judge ruled that no
irreparable harm had come from the mention of "Dr. Oppenheim."  
After they began deliberating, however, the jurors sent out a
question:  "Who sat on the Arbitration Panel?  Were they health
professionals and/or lay people?"   Although Linzey denies that
counsel's mention of "Dr. Oppenheim" caused the jury to ask the
question, the trial transcript reveals that the trial judge
believed that the mention of "Dr. Oppenheim" led directly to the
jury question.  While the jury's desire for this information would
not be surprising under any circumstances, we do not fault the
trial judge's assumption that there was a causal connection between
the mention of "Dr. Oppenheim" and the jury's question.
-6-
After consulting with counsel, the trial judge re-instructed
the jury.  This time he told the jury both of the composition of
the panel and that its decision had not been unanimous:
"The law in Maryland provides that the Health
Claims Arbitration Boards consist of one
layperson, one lawyer and one health care
professional.  In this case those were the
three categories of persons who sat on the
Health Claims Arbitration Board, and that
board ruled, as you know, in favor of Mr.
Linzey, the Plaintiff, by a two-to-one vote.
Unlike the jury system in Court, the verdict
of the Health Claims Arbitration Board need
not be unanimous."
The jury retired again to consider the instruction.
Eventually they returned a verdict nullifying the arbitration
panel's decision, and finding Carrion not liable to Linzey for his
injuries.  Linzey's motion for new trial was denied and he appealed
to our intermediate appellate court.
The Court of Special Appeals, in Linzey v. Carrion, supra,
held that it is always proper for a trial judge to inform the jury
about certain statutory facts, including the standard membership of
an arbitration panel and that a decision by the panel need not be
unanimous.  The court held, however, that informing the jury of the
split decision of the panel in a specific case served to weaken the
statutory presumption of correctness impermissibly.  As a result,
the court reversed the judgment and remanded the case for a new
trial.  We granted Carrion's petition for a writ of certiorari to
review that decision.
-7-
II.
Carrion's argument in this Court is based on two contentions.
First, he suggests that unless otherwise instructed, a jury would
assume that an arbitration panel decision, like the jury's own
decision, must be unanimous.  Thus, when an arbitration panel finds
in favor of the plaintiff, the jury will infer that the panel's
health-care provider, a neutral expert, found the defendant's
conduct to be negligent.  Second, Carrion argues, the jury will
likely place considerable weight on the determination of a neutral
expert, and so the jury's erroneous assumptions will be
particularly damaging to the defendant.  Carrion points out that
this string of inferences is most damaging in cases such as his,
where the arbitration panel's health-care provider actually
dissented from the finding of liability but the jury is not
informed of the dissent.
Alternatively, Carrion argues that even if it is not
ordinarily permissible to tell a jury that an award was not
unanimous, the instruction given by the trial court in this case
was appropriate to remedy the damage caused by opposing counsel's
mention of "Dr. Oppenheim."
Linzey argues that any mention of the panel's vote weakens the
legal presumption of correctness of the panel's decision.  He
stresses that the presumption of correctness advances the important
policy goal of reducing medical malpractice litigation by forcing
-8-
potential malpractice litigants to marshal a complete evidentiary
showing in the arbitration hearing, and thereby increasing the
number of cases that are resolved at the arbitration hearing stage.
III.
A.
The History of the Health Claims Arbitration Act.
The history of the medical malpractice insurance crisis that
occurred in Maryland in the mid-1970s has been documented
extensively elsewhere, so here we merely sketch the history.  See,
e.g., Harry J. McGuirk & F. Thomas Rafferty, Medical Malpractice
and the Maryland Legislature, 6 MD. L. FORUM 9 (1976); James Kevin
MacAlister & Alfred L. Scanlon, Jr., Health Claims Arbitration in
Maryland:  The Experiment Has Failed, 14 U. BALT. L. REV. 481, 487-90
(1985).
Despite being granted a large rate increase in 1974, St. Paul
Fire & Marine Insurance Company ["St. Paul"], then Maryland's
largest malpractice insurance carrier, gave notice in 1975 that it
intended to withdraw from the market as St. Paul considered it no
longer profitable.  The State Insurance Commissioner issued an
order prohibiting St. Paul's withdrawal and requiring it to
continue to provide insurance coverage.  The Baltimore City Court
affirmed the Insurance Commissioner's order.  This Court reversed,
holding that the Insurance Commissioner could not require St. Paul
to remain in the medical malpractice liability insurance market.
-9-
Our order, issued immediately after oral argument, did not become
valid until several months later when the opinion was issued.  The
delay between our order and its effective date permitted the
General Assembly sufficient time to act to avert a crisis.  St.
Paul Fire & Marine Ins. Co. v. Insurance Comm'r, 275 Md. 130, 309
A.2d 291 (1975).
The General Assembly responded by creating the Medical Mutual
Liability Society of Maryland.  Ch. 544 of the Acts of 1975
codified as Md. Code (1957, 1972 Repl. Vol., 1977 Cum. Supp.), Art.
48A, §§ 548-556.  This non-profit insurance company quickly became
the primary insurer of Maryland's physicians.  Attorney General v.
Johnson, 282 Md. 274, 280-81, 385 A.2d 57, 61 (1978).  The
Legislature also shortened the statute of limitations for
instituting medical malpractice claims, ch. 545 of the Acts of
1975, codified as  § 5-109, and passed a law to promote peer review
for physicians, ch. 423 of the Acts of 1975, codified as Md. Code
(1981, 1994 Repl. Vol., 1995 Cum. Supp.), § 14-501 et seq. of the
Health Occupations Article.  
Most importantly, the General Assembly created a committee to
study methods of reforming the manner in which the legal system
responds to claims of medical malpractice.  The Medical Malpractice
Study Committee was appointed on July 23, 1975, and on January 6,
1976, issued its report.
-10-
The Committee proposed adoption of a mandatory medical
malpractice arbitration system in Maryland, contending that such a
system would improve on the traditional tort system in several
ways.  First, effective arbitration would discourage litigation of
non-meritorious claims, because, in part, evidentiary weaknesses
would become apparent during the arbitration stage.  Second,
arbitration would encourage the early settlement of meritorious
claims, because a panel finding of liability would encourage health
care professionals and their insurance carriers to settle.  Third,
the Committee believed that the expertise of the panel members, as
opposed to jurors, would lead to accurate decisions in more cases
as well as reasonable and predictable damage awards.  Accompanying
the text of the committee report was proposed legislation, which
ultimately was adopted as ch. 235 of the Acts of 1976, and codified
as § 3-2A-01, et seq.
B.
Features of the Health Claims Arbitration Act.
In Attorney General v. Johnson, 282 Md. 274, 385 A.2d 57
(1978), we reviewed the salient features of the Health Claims
Arbitration Act.  We emphasized that the primary feature of the new
system was to "require the submission of certain [medical
malpractice] 
claims 
to 
an 
arbitration 
panel 
for 
initial
ascertainment of liability and damages before resort may be had to
a court of law for final determination," i.e., mandatory
-11-
      During its 1995 session, the General Assembly adopted a major change in
3
the Health Claims Arbitration Act, by permitting waiver of the entire arbitration
system at the discretion of either party.  Ch. 582 of the Acts of 1995, codified
as § 3-2A-06B.
arbitration.   Id. at 277, 385 A.2d at 59.  We went on to discuss
3
the specific features of the system:
"All malpractice claims against health care
providers seeking damages of more than $ 5,000
are subject to the provisions of the Act, and
must be initially filed, as must the responses
to them, with the Health Claims Arbitration
Office, created by the statute `as a unit in
the Executive Department.'  The office, acting
through its director, refers all issues raised
to a three-member arbitration panel, chosen at
random 
from 
lists 
of 
qualified 
persons
prepared and maintained by the director; the
panel for each claim is to be composed of an
attorney, a health care provider, and a member
of the general public.  The arbitration panel
determines whether the health care provider is
liable to the claimant and if so the extent of
the damages, and incorporates in its award an
assessment of costs, including arbitrators'
fees; if no party rejects the award, it
becomes final and binding, is filed by the
director with the appropriate circuit court,
and when confirmed by that court constitutes a
final judgment.  Neither party, however, is in
any way bound to accept the award; it may be
rejected for any reason within ninety days.
If a party desires to contest the decision of
the panel, he must file an action in the
appropriate court during the ninety-day period
to  nullify the award, and jury trial may be
elected by either party.  Any contention that
an award should be vacated on the ground of
corruption, fraud, partiality or the like is
to be decided by the court prior to trial.
Unless the award is thus vacated, it is
admissible as evidence at the trial and
presumed to be correct, with the burden of
proving the contrary falling on the party
rejecting it; should the award be vacated,
`trial of the case shall proceed as if there
-12-
had been no award.'  In addition, attorneys'
fees 
are 
subjected 
to 
the 
approval
respectively of the arbitration panel and the
court."
Id. at 279-80, 375 A.2d at 60-61 (citations and footnotes omitted).
See also James Kevin MacAlister & Alfred L. Scanlon, Jr., Health
Claims Arbitration in Maryland:  The Experiment Has Failed, 14 U.
BALT. L. REV. 481, 493-97 (1985).  Of particular significance to the
case sub judice is the statutory presumption of correctness that
attaches to the decision of an arbitration panel in a subsequent
circuit court judicial review.
C.
The Presumption of Correctness.
We begin with an analysis of the statutory presumption of
correctness for two related reasons.  First, the admissibility of
the arbitration panel's membership and voting is, at its center, a
question concerning how a party that lost at the arbitration stage
may attack the presumption of correctness.  Determining the
"strength" of that presumption is thus vital to an understanding of
the methods that may be employed to attack the presumption.
Second, there are several theories regarding the effect of
presumptions generally.  Each of these theories carries with it
correlative principles about instructing a jury about the effect of
the presumption.  For us to determine what a jury can be told about
the panel membership and vote, we must understand the theories of
presumptions that may apply.
-13-
      For two good overviews of the variety of attempts made by state
4
legislatures to divert medical malpractice claims from the traditional tort
system, see Note, Medical Malpractice Arbitration:  A Comparative Analysis, 62
VA. L. REV. 1285 (1976); Kenneth S. Abraham, Medical Malpractice Reform:  A
Preliminary Analysis, 36 MD. L. REV. 489 (1977).
Although many states have adopted systems of arbitration for
medical 
malpractice 
claims, 
the 
statutory 
presumption 
of
correctness given a panel decision in subsequent litigation is a
feature 
unique 
to 
Maryland's 
system. 
 
Comment, 
The
Constitutionality of Medical Malpractice Mediation Panels:  A
Maryland Perspective, 9 U. BALT. L. REV. 75, 76 n.7 (1979).  In the
arbitration schemes adopted by other states, the panel decision may
or may not even be admissible.   Our sister states can thus provide
4
no guidance.  
Instead we will make a three part inquiry, looking at
presumptions under general Maryland law, examining the legislative
history of the presumption of correctness contained in this
statute, and by reviewing our decisions regarding this presumption.
1.
Presumptions Generally.
Effective July 1, 1994, this Court for the first time adopted
an evidence code for the courts of Maryland.  Among the rules
adopted was Rule 5-301 (a), which provides:
"Effect [of Presumptions in Civil Actions]. -
Unless otherwise provided by statute or by
these 
rules, 
in 
all 
civil 
actions 
a
presumption imposes on the party against whom
it is directed the burden of producing
evidence to rebut the presumption. If that
-14-
party introduces evidence tending to disprove
the presumed fact, the presumption will retain
the effect of creating a question to be
decided by the trier of fact unless the court
concludes that such evidence is legally
insufficient or is so conclusive that it
rebuts the presumption as a matter of law."
The comments of the Court of Appeals Standing Committee on
Practice and Procedure indicate that this rule is intended to
codify the approach of this Court in Grier v. Rosenberg, 213 Md.
248, 131 A.2d 737 (1957), and rejects both the "Thayer-Wigmore
bursting bubble" approach found in Fed. R. Evid. 301 and the
"Morgan-type" presumption of Unif. R. Evid. 301 (1986).  Under the
"bursting bubble" theory of presumptions,
"a presumption operates in favor of a party
who has the burden of proof by shifting to the
other party the duty of going forward with the
evidence on the issue.  In effect, this means
that the party relying on the presumption can
get past a motion for a directed verdict made
at the close of his case without any direct
proof of the presumed fact, and may succeed
with respect to that issue if the other party
does not come forward with evidence. . . .
Once the other party produces evidence on the
issue sufficient to support a finding contrary
to the presumed fact, the bubble is burst and
the presumption no longer exists in the case."
Note, Presumptions in Civil Cases:  Procedural Effects Under
Maryland Law in State and Federal Forums, 5 U. BALT. L. REV. 301,
305-06 (1976) (footnotes omitted).  In a "bursting bubble"
presumption, the jury is never told about the presumption.  Id. at
306.  
-15-
      The Morgan-type presumption is embodied in the approach adopted by the
5
UNIF. R. EVID. 301:  "a presumption imposes on the party against whom it is
directed the burden of proving that the nonexistence of the presumed fact is more
probable than its existence."
Alternatively, a Morgan-type presumption shifts the burden of
persuasion on a given issue.  Graham C. Lilly, An Introduction to
the Law of Evidence 54 (1978) (citing Edmund Morgan, Some Problems
of Proof 74-81 (1956)).   In a Morgan-type presumption there is no
5
need to inform the jury of the presumption, only of the allocations
of the burden of persuasion.
Instead of either of these approaches, we adopted Md. Rule 5-
301.  Although Md. Rule 5-301 was not itself in effect when the
instant case was tried in June of 1993, it merely codified the
existing common law of Maryland, and so the same principle applied.
As Professor Alan Hornstein of the University of Maryland, School
of Law explains it:
"Under Rule 5-301 [and the common law rule
that 
preceded 
the 
rule's 
adoption],
presumptions do not affect the burden of
persuasion.  A presumption merely satisfies
the burden of production on the fact presumed
and, in the absence of rebutting evidence, may
satisfy the burden of persuasion.  If there is
rebutting evidence, the presumption retains
only enough vitality to create a jury question
on the issue, and the jury is instructed on
the presumption."
Alan D. Hornstein, The New Maryland Rules of Evidence:  Survey,
Analysis and Critique, 54 MD. L. REV. 1032, 1049 (1995).  Maryland
Rule 5-301, therefore, describes the effect that a presumption
should have unless a specific presumption is given more or less
-16-
      In Newell v. Richards, 323 Md. 717, 594 A.2d 1152 (1991), we made clear
6
that the analogy between the presumption of correctness in an appeal from the
Workers' Compensation Commission and the presumption of correctness in a judicial
review of a decision of a Health Claims Arbitration panel is flawed.  Id. at 731-
33, 594 A.2d at 1159-60.
weight by rule, statute, or judicial interpretation.  Alone among
the three theoretical models, the Md. Rule 5-301 presumption
requires informing the jury of the existence of the presumption.
As our predecessors said in Grier v. Rosenberg, 213 Md. 248, 131
A.2d 737 (1956), "if the instruction [on the existence of a
presumption] be not granted, how is the jury to know of the
presumption?"  Id. at 253, 131 A.2d at 739.  See also Note,
Presumptions in Civil Cases:  Procedural Effects Under Maryland Law
in State and Federal Forums, 5 U. BALT. L. REV. 301, 310-11 (1976).
2.
Legislative History of Presumption of Correctness in the
Health Claims Arbitration Act.
The Medical Malpractice Study Committee's proposal to adopt
mandatory medical malpractice arbitration included a description of
the following feature of the proposed system:
"5.  Any party shall have the right to reject
an award and file an action in court, with the
right of de novo trial before judge or jury.
However, the award is admissible in evidence
and given a presumption of correctness, in the
same 
manner 
as 
Workmen's 
Compensation
Commission awards.[ ]  Moreover, if the
6
rejecting party (appellant) does not receive a
verdict more favorable to him than the award
he rejected, he will pay the costs of the
judicial proceedings."
-17-
Accompanying the text of the report is proposed legislation, which
became the genesis of the HCA Act, adopted as ch. 235 of the Acts
of 1976.  Each version, from the Committee's initial proposal to
that enacted in 1976 contained similar language:
"Unless vacated by the court pursuant to
subsection (c), the arbitration award is
admissible 
as 
evidence 
in 
the 
judicial
proceeding.  The award shall be presumed to be
correct, and the burden is on the party
rejecting it to prove that it is not correct."
Ch. 235 of the Acts of 1976.
With the single exception of the addition of the adjective
"unmodified" before the word "arbitration" by ch. 596 of the Acts
of 1987, the provision has remained unchanged since adoption.
Section 3-2A-06 (d).  Similar language is found in the Md. Rules:
"Unless the arbitration award is vacated
pursuant to Code, § 3-2A-06 (c), Courts
Article, it is admissible as evidence and the
burden of proof is on the party rejecting the
award to show that it is not correct."
Md. Rule BY5.
While the Medical Malpractice Study Committee was doing its
research in the fall of 1975, the Maryland State Bar Association
["MSBA"] apparently became concerned about the proposals being
discussed.  In August of 1975, MSBA president, Wilbur D. Preston,
Jr., Esq. appointed a "Special Committee to Study Problems Related
to Medical Malpractice in Maryland."  The MSBA Special Committee's
report was adopted in a series of resolutions by the Board of
-18-
      It is interesting to note that Professor Abraham, in a law review article
7
published approximately one year after the adoption of the Health Claims
Arbitration Act, discussing the appeal provisions of various medical malpractice
arbitration systems, did not mention Maryland's presumption of correctness of the
panel decision.  Kenneth S. Abraham, Medical Malpractice Reform:  A Preliminary
Analysis, 36 MD. L. REV. 489, 515 (1977).
Governors of the MSBA.  Those resolutions proposed a non-binding,
screening panel as well as a lesser weight to be assigned the
arbitrators' decision in a subsequent trial:
"5.  The [arbitration] panel would issue a
brief written decision as to liability and
damages, if any, stating also the facts upon
which its determinations are based.  The
panel's written decision and any dissenting
opinion would be admissible at any subsequent
trial, if in conformity with applicable law
and not arbitrary or capricious.  Panel
members themselves would not be subject to
subsequent subpoena.  In the event that the
decision of the screening [arbitration] panel
is in favor of the plaintiff, the defendant
could offer to settle the dispute for the
amount of damages awarded by the panel.  If
the plaintiff rejects this offer, then the
decision of the panel . . . should not be
admissible over that defendant's objection at
a subsequent trial of the case."  (Emphasis
added).
The proposals of the MSBA special committee were explained to
"three standing Committees of the Maryland General Assembly," by
Kenneth S. Abraham, Esq., Vice Chairman of the Special Committee,
and an Assistant Professor of Law at the University of Maryland.7
Looking back, we can say with some assurance that the General
Assembly was aware of the broad range of legislative choices it
faced in creating the Health Claims Arbitration system.  Despite
-19-
      The Health Claims Arbitration Act does not refer to a dissenting vote at
8
all.  The general arbitration statute, Md. Code (1974, 1995 Repl. Vol.), § 3-201
et seq., of the Courts and Judicial Proceedings Article states that "the majority
of the arbitrators may determine any question and render a final verdict."
Section 3-215 of the Courts and Judicial Proceedings Article.  The regulations
promulgated by the Health Claims Arbitration Office governing the form that
arbitration awards must take seem to exclude the possibility of a dissenting
opinion by a panel member:
"E.
Form of Award.
(1)
Within 5 days after the close of the
hearing, the arbitration panel shall submit
to the Director a written award that
concisely states the following information:
(a)
With respect to each health care
provider, that he was liable or that
he was not liable;
(b)
If applicable, the amount of damages
calculated under §C, above; [and]
(c)
The 
arbitration 
costs 
and 
any
apportionment 
made 
under 
§D,
above[.]"
COMAR 01.03.01.12 (E).  While it would be interesting and useful to know, the
record does not reflect if arbitration awards frequently reflect a dissenting
vote as Carrion's counsel suggested in oral argument.
the MSBA's recommendation that a dissenting opinion by a panel
member be admissible at the subsequent trial, the General Assembly
chose to remain silent on the issue.   The Legislature also
8
intentionally created a system wherein the panel decision was
admissible as evidence and presumed correct at the subsequent
trial, contrary to the stated wishes of the MSBA.  
The General Assembly, by each of its actions, chose that
option that made success on judicial review more difficult for the
party that lost at the arbitration panel.  From these legislative
choices, we infer the General Assembly's strong preference to
dispose of a majority of medical malpractice cases in the
-20-
      In 1983, a Medical Malpractice Task Force, chaired by the late State
9
Senator Harry J. McGuirk of Baltimore City, studied the Health Claims Arbitration
system.  Despite several recommendations to eliminate the presumption of
correctness of the arbitration panel decision, the Task Force refused to
recommend the repeal of the presumption.  Minutes of January 10, 1983, at 3.  For
testimony urging elimination of the presumption, see testimony of Barry J. Nace,
Esq., minutes of October 14, 1982, at 4; testimony of Albert D. Brault, Esq.,
minutes of November 23, 1982, at 4-5; and testimony of Dr. Manning W. Alden,
President of the Medical Mutual Liability Insurance Society of Maryland, minutes
of November 23, 1982, at 6.
       Judge Solomon Liss explained this Homeric allusion in Cooper v. State,
10
34 Md. App. 124, 366 A.2d 385 (1976):
"One of the hazards of Ulysses' journey was to traverse
the narrow channel between Scylla, the six-headed
monster who sat on a rock, and Charybdis, another
monster who by sucking in water created a whirlpool.  In
avoiding the whirlpool Ulysses passed too close to
Scylla who seized six of his sailors and ate them. 
Jason and his Argonauts had a somewhat more successful
adventure with the clashing rocks which guarded the
(continued...)
arbitration system and minimize the number of cases brought to
trial in the traditional tort system.9
3.
Judicial Interpretation of the Presumption of Correctness
in the Health Care Arbitration Act.
Our experience in reviewing cases arising under the Health
Claims Arbitration Act has been similar to Ulysses' journey through
the Bosporus Straits:  an attempt to avoid on one side the Scylla
of the constitutional infirmity of not permitting a trial by jury,
and on the other, the Charybdis of the expense and redundancy of an
arbitration system whose decisions are uniformly challenged in
court.  A careful review of our decisions regarding the presumption
of correctness reveals the compromise we have struck between these
two evils.10
-21-
     (...continued)
10
entrance to the Bosporus Straits.  By following the
advice of Phineas to send a dove between the rocks first
he was able to traverse the passageway without injury to
his ship or his sailors.  The dove lost a few tail
feathers and his dignity."
Id. at 132 n.7, 366 A.2d at 390 n.7.
This Court first reviewed the presumption of correctness in
Attorney General v. Johnson, 282 Md. 274, 385 A.2d 57 (1978).  The
plaintiffs in that case, seeking to avoid mandatory arbitration,
challenged the HCA Act on multiple constitutional grounds,
including separation of powers, due process, and equal protection.
Relevant here was plaintiff's assertion that the presumption of
correctness "virtually deprived the jury of its constitutional
function."  Id. at 292, 385 A.2d at 67.  Johnson argued that a jury
would be so influenced by the decision of the arbitration panel
that it would abdicate its essential constitutional role as finder
of fact and simply defer to the panel.  
Not sharing Johnson's skepticism about Maryland juries, we
disagreed.  We held that the presumption of correctness was a mere
rule of evidence, acting to create a rebuttable presumption.  "It
cuts off no defense, interposes no obstacle to a full contestation
of all the issues, and takes no question of fact from either court
or jury."  Id. at 294-95, 385 A.2d at 69 (quoting Meeker v. Lehigh
Valley R.R., 236 U.S. 412, 430, 35 S. Ct. 328, 335, 59 L. Ed. 644,
657 (1915)).  We also analogized the presumption to that employed
in the workers' compensation setting and in the provisions of the
-22-
      The analogy to workers' compensation law would later prove to have been
11
an unfortunate one.  In Newell v. Richards, 323 Md. 717, 594 A.2d 1152 (1991),
we made clear that the differences between this statute and the workers'
compensation were greater than the similarities between the two.  While the
presumption of correctness in workers' compensation law serves to shift the
burden of persuasion (and even the order of presentation) in a workers'
compensation case, no such shift of the common law burden of persuasion occurs
in medical malpractice law.
Maryland Constitution requiring just compensation for public
takings.  Id. at 293-96, 385 A.2d at 68-70.11
In Su v. Weaver, 313 Md. 370, 545 A.2d 692 (1988), an
arbitration panel found liability on the part of the defendant-
physician with respect to a claim of negligence during the post-
operative period, but not as to the other claims of negligence in
diagnosis and surgery.  The Su Court opined that a failure to tell
the jury that the arbitration panel had found for the defendant on
two counts might have led the jury to presume erroneously that the
panel had found for the plaintiff on all counts.  To avoid this
confusion, and the potentially unfair advantage resulting from it,
we held that "when the issues of liability are sufficiently
separate and distinct, the decision of the arbitrators as to each
of those issues should be set forth in the award, and in the event
of a judicial proceeding following arbitration, these decisions
should be made known to the jury."  Id. at 382, 545 A.2d at 698.
Carrion argues that Su stands for the principle that if a jury
might be mislead about the decision of an arbitration panel, a
trial judge should take appropriate steps to dispel the confusion.
-23-
We most recently took up the issue of the presumption of
correctness in Newell v. Richards, 323 Md. 717, 594 A.2d 1152
(1991).  The Court of Special Appeals had held, in Hahn v. Suburban
Hospital Ass'n, 54 Md. App. 685, 461 A.2d 7 (1983), that the
presumption of correctness under the Health Claims Arbitration Act
served to shift the common law burden of proof from plaintiff to
defendant.  Under that reading, a defendant who lost before the
arbitration panel would have the burden of disproving his alleged
negligence at the circuit court trial.  Our decision in Newell
explicitly overruled Hahn and made clear that the presumption of
correctness does not shift the common law burden of proof.  As we
explained the permutations in Newell:
"Shifting the common law burden of proof based
on the health claims panel award would
penalize an unsuccessful health care provider
far more than an unsuccessful claimant. If
either the claimant or health care provider is
unsuccessful at arbitration, the award is
admissible and will have evidentiary impact on
the trier of fact. If the claimant is
unsuccessful at arbitration, the burden of
proof was on the claimant before arbitration
and will be on the claimant after arbitration.
Thus, as far as the burden of proof is
concerned, the unsuccessful claimant is in the
same position as if arbitration had not
occurred. On the other hand, if the health
care provider is unsuccessful at arbitration,
in addition to the evidentiary effect of the
adverse award, the health care provider would
be further penalized by a shifting of the
usual burden of proof as the result of the
arbitration award."
-24-
Newell, 323 Md. at 733, 594 A.2d at 1160.  Newell also overruled
that part of Johnson which relied on an analogy to the workers'
compensation system to establish a shift in the burden of proof. 
Finally, in Crawford v. Leahy, 326 Md. 160, 604 A.2d 73
(1992), we rejected an argument that an injured party could reject
only the damages portion of an arbitration panel's award.  Instead,
we held that a party must reject all or none of the arbitration
panel's award.  Although we did not base this decision on the
presumption of correctness, we did make clear that the purpose of
the presumption was "to deter rejection of panel decisions."  Id.
at 175, 604 A.2d at 80.  Because permitting a party to appeal the
quantum of damages only, without putting at risk the favorable
determination 
on 
liability, 
would 
have 
the 
opposite
effect—encouraging appeals—we rejected it.  Id.
4.
Conclusions about the Presumption of Correctness in § 3-
2A-06 (d).
We shall hold today that the effect of the presumption of
correctness found in § 3-2A-06 (d) is exactly the effect described
by Md. Rule 5-301.  At the subsequent trial de novo, the party
challenging the decision of the arbitration panel has the burden of
producing evidence tending to disprove the panel's decision.  Once
this burden of production is met, the presumption retains enough
vitality so that, without any other evidence, the party that
prevailed at the panel can get to the jury.  As we said in Newell
-25-
v. Richards, 323 Md. 717, 594 A.2d 1152 (1991), the burden of
persuasion never shifts in a medical malpractice case, and as at
common law, the plaintiff must carry this burden.
Were we to adopt instead the "bursting bubble" theory, we
would fail to give full effect to the Legislature's intention to
maximize the number of cases resolved in the arbitration stage,
because production of a sufficient quantum of evidence would
destroy the presumption, and because the jury would not be informed
of the presumption.  Alternatively, adoption of the Morgan-type
presumption would likely violate the defeated party's right to
trial, and certainly require us to overrule Newell v. Richards, 323
Md. 717, 594 A.2d 1152 (1991).
Moreover, were we to adopt another theory of presumptions, we
would be, in effect, changing sub silentio the appropriate jury
instruction.  In Newell v. Richards, 323 Md. 717, 734, 594 A.2d
1152, 1160-61 (1991), we approved a jury instruction informing the
jury of the presumption of correctness.  As discussed previously,
under neither the "bursting bubble" nor the Morgan-type presumption
is the jury notified of the existence of a presumption.  Only if
the presumption of correctness is given the weight prescribed in
Md. Rule 5-301 is the jury informed of the presumption.  Thus,
Newell foreshadowed the adoption of this standard.
For all of these reasons, the statutory presumption of
correctness of § 3-2A-06 (d) is to be given the weight and force
-26-
described by Md. Rule 5-301 and Grier v. Rosenberg, 213 Md. 248,
131 A.2d 737 (1956).
IV.
We next turn to the issue of the ethical considerations
involved in Carrion's counsel obtaining Dr. Oppenheim's affidavit.
The Health Claims Arbitration Office regulations provide:
"G.
Contact 
with 
Panel 
Candidates 
and
Members.
(1)
Except as provided in §G(2), below,
a party or his counsel may not
communicate 
directly 
with 
an
arbitration 
panel 
candidate 
or
member concerning the claim.
(2)
A 
party 
or 
his 
counsel 
shall
communicate with a member of the
arbitration panel only by either of
the following means:
(a)
Written communication submitted
to the Chairman of the panel
and served on the other parties
or their counsel;
(b)
Oral communication with the
panel member in the presence of
the other parties or their
counsel."
COMAR 01.03.01.07 (G).  The Maryland Rules of Professional Conduct
provide that a lawyer "shall not:  . . . communicate ex parte about
an adversary proceeding with the judge or other official before
whom the proceeding is pending, except as permitted by law; . .
. ."  Rule 3.5 (a) (7).
-27-
This case was tried before the arbitration panel for four days
concluding on March 5, 1992.  The award of the panel was signed by
the chairperson on that same day.  The affidavit from Dr. Oppenheim
is dated March 24, 1992, nineteen (19) days after the issuance of
the award.
Linzey alleges that Carrion's discussion with Dr. Oppenheim,
which occurred within the 30-day period during which a party may
ask the arbitration panel to modify or correct an award,
constituted an ex parte communication in violation of both the
regulations of the Health Claims Arbitration Office and the
Maryland Rules of Professional Conduct.
We discern nothing in counsel's activities that violated the
quoted regulations or the Rule of Professional Conduct set forth
above.  After an arbitration panel makes its award, there are no
remaining tasks for the health care provider or layperson panel
members.  Only the panel chair has duties during the period
subsequent to the award:
"(h) 
 
Application 
for 
modification 
or
correction; 
request 
for 
reduction 
of
damages. 
- 
A 
party 
may 
apply 
to 
the
arbitration panel to modify or correct an
award as to liability, damages, or costs in
accordance with § 3-222 of this article. . . .
The panel chairman shall receive such evidence
in support and opposition to a request for
reduction, including evidence of the cost to
obtain 
such 
payment, 
reimbursement, 
or
indemnity. After hearing the evidence in
support and opposition to the request, the
panel chairman may modify the award if
-28-
     
 Language found in the regulations of the Health Claims Arbitration
12
Office, COMAR 01.03.01.13, that suggests, contrary to the statute, that
modification is a joint task of the entire arbitration panel ("An arbitration
panel may modify its award. . .") is invalid and of no effect.  Fogle v. H & G
Restaurant, Inc., 337 Md. 441, 463-64, 654 A.2d 449, 460 (1995).
      We also reject Linzey's argument that there is no competent evidence to
13
support Carrion's assertion that this was a 2-1 decision by the arbitration
panel.  The affidavit prepared by Dr. Oppenheim is a clear statement given under
oath that he dissented from the award.  Linzey has offered no suggestion that the
affidavit is not valid or that its contents are untrue.  Furthermore, it was
attached as an appendix to Carrion's motion in limine, and therefore properly
before the trial judge.  Consequently, the statement to the jury that the vote
of the arbitration panel was 2-1 was not erroneous on the basis of a lack of
factual predicate.
satisfied that modification is supported by
the evidence." 
§ 3-2A-05 (h) (emphasis added).   Therefore, counsel's contact with
12
Dr. Oppenheim came subsequent to the pendency of the arbitration,
at least as it concerned Dr. Oppenheim, and thus violates neither
COMAR 01.03.01.07 (G), nor Maryland Rules of Professional Conduct,
Rule 3.5 (a) (7).13
V.
We turn now to the heart of this case, the jury instructions.
We must determine if the instructions given were consistent with
our understanding of the statutory scheme of the Health Claims
Arbitration Act generally, and the presumption of correctness
specifically.  As discussed above, the trial judge initially
refused to instruct the jury about either the arbitration panel's
membership or its split decision, telling them only of the
presumption of correctness in accordance with the Maryland Civil
-29-
      We specifically approved this instruction in Newell v. Richards, 323 Md.
14
717, 734, 594 A.2d 1152, 1160-61 (1991).
Pattern Jury Instructions, § 27:2 (2d ed. 1984).   Later, however,
14
in response to the jury's inquiry about the membership of the
panel, he reinstructed the jury.  We repeat that instruction:
"The law in Maryland provides that the Health
Claims Arbitration Boards consist of one
layperson, one lawyer and one health care
professional.  In this case those were the
three categories of persons who sat on the
Health Claims Arbitration Board, and that
board ruled, as you know, in favor of Mr.
Linzey, the Plaintiff, by a two-to-one vote.
Unlike the jury system in Court, the verdict
of the Health Claims Arbitration Board need
not be unanimous."
The Court of Special Appeals held that this instruction
constituted reversible error.  Although we shall ultimately reverse
that decision based on the specific facts in this case, the
framework of the court's analysis is correct and we adopt it.  In
evaluating the trial judge's instructions, the Court of Special
Appeals drew a distinction between jury instructions based on
information 
gleaned 
from 
the 
enabling 
statute 
and 
those
instructions based on the particular facts of the specific case.
The court would approve of instructing the jury on three facts
derived from the statute:
1.
that the health claims arbitration panel
was composed of a lawyer, a health care
-30-
      It is also permissible to indicate the health care specialty of a panel
15
member, where, as here, that panel member was selected because of a specialty
similar or identical to that of the defendant.
provider  and a lay person (§ 3-2A-03
15
(c));
2.
that the decision of a majority of an
arbitration panel is the decision of the
panel, i.e., that a panel's decision need
not be unanimous (§ 3-215); and
3.
that the decision of the arbitration
panel is entitled to a presumption of
correctness (§ 3-2A-06 (d)).
We agree with the Court of Special Appeals that these facts
are appropriate information to provide the jury.  This information
provides the context for the jury to understand and weigh the
panel's decision as they are required to do by the statute.  As the
Court of Special Appeals stated, these "are matters established by
law, and there ought to be no secret about them."  Linzey v.
Carrion, 103 Md. App. at 125, 652 A.2d at 1158.  Giving a jury
instruction which explains the presumption of correctness is
consonant with Md. Rule 5-301.  Moreover, the use of these
instructions, by explaining the arbitration process and making the
jury more familiar with the panel's expertise, will tend to enforce
the presumption of correctness.  Instructing the jury in this
manner will also avoid the vice that Carrion initially feared, that
a jury would believe that the panel's vote must be unanimous, and
thus be led to conclude that the panel had voted unanimously, when,
-31-
in fact, a member had dissented.  We encourage trial judges to add
these facts to their standard jury instructions.
Unfortunately, however, the trial judge's instructions went a
step further.  He told the jury that in this specific case the
panel vote had been two-to-one.  The Court of Special Appeals held
that this information was improperly given to the jury as it
undermined the statutory presumption of correctness.  Id. at 125-
126, 1158-59.
Under most circumstances we would agree.  A jury normally has
no need for this case-specific information.  When Carrion's counsel
states that it is "his job" to attack the presumption of
correctness of the arbitration panel decision, we agree to the
extent that counsel seeking to reverse an adverse panel decision
should attack the substance of that decision.  The attack may
involve an infinite variety of challenges both to the evidence
offered below and to the panel's interpretation of that evidence.
We disagree with Carrion, however, that the attack should include
a dissection of the panel vote itself.  Challenging collateral
aspects of the arbitration decision, however, should generally be
off limits for jury argument or instruction, because if the
decision is procedurally valid it must be presumed correct.
Examples of such collateral challenges would include argument that
a decision was not unanimous; that the health care provider/panel
member was not of a sufficiently similar specialty to the
-32-
      Fears have been expressed that health care providers will be predisposed
16
to oppose damage awards because of the effect such awards may have on their own
insurance rates, particularly given the fact that 90% of Maryland physicians are
insured by the same insurer, the Medical Mutual Liability Insurance Society of
Maryland.  Comment, The Constitutionality of Medical Malpractice Mediation
Panels:  A Maryland Perspective, 9 U. BALT. L. REV. 75, 79 n.29 (1979).  Our
discussion of such concerns should not be taken as an expression that we share
them.
defendant; or that the health care provider/panel member, by virtue
of his or her profession, was biased against the plaintiff.   Such
16
collateral challenges are almost never appropriate.
On the facts of this case, however, where the plaintiff
violated the trial judge's order in limine banning the mention of
the panel's membership, we will not create an absolute rule that to
instruct the jury about a collateral matter is fatally erroneous.
While we have made it clear that we would instruct the jury
differently, the trial judge's obvious intent in his order in
limine was, quite properly, to strike a delicate balance between
Linzey's right to the presumption of correctness and Carrion's
right to try his case.  When Linzey's counsel mentioned "Dr.
Oppenheim" in direct violation of the judge's order, that balance
was tilted precariously.  
Although Linzey emphasizes that each of the panel members
could correctly be referred to as "doctor," and that his reference
to "Dr. Oppenheim" did not necessarily imply a medical doctor or
dentist, the trial judge concluded that the comment led the jury to
discover that the panel included a health care professional.
Allowing this information to stand, without more, would have
-33-
permitted the jury to infer erroneously that the panel's health
care provider member had found Carrion liable for malpractice.  
In Su v. Weaver, infra, we held that a trial court should take
steps to avoid a jury reaching a misunderstanding about the panel's
decision.  In the instant case, the trial judge took active steps
to avoid the jury's possible misunderstanding and to restore the
balance initially upset by Linzey's counsel.  In this spirit, he
instructed the jury about the split decision of the panel.  We
hold, therefore, that under the circumstances of the instant case,
the trial judge did not abuse the discretion vested in him to
choose the cure for the prejudicial statement made by Linzey's
counsel in violation of the order in limine.  DeMay v. Carper, 247
Md. 535, 540, 233 A.2d 765, 768 (1966); Drug Fair of Maryland, Inc.
v. Smith, 263 Md. 341, 353-54, 283 A.2d 392, 399 (1971).
JUDGMENT OF THE COURT OF SPECIAL
APPEALS REVERSED; CASE REMANDED TO
THAT COURT WITH DIRECTIONS TO AFFIRM
THE JUDGMENT OF THE CIRCUIT COURT
FOR BALTIMORE CITY; COSTS TO BE PAID
BY THE RESPONDENT.