Case Title: Anderson v. United States

Citation: 

Docket Number: 14m/11

State: maryland

Court: Maryland Supreme Court

Date: 2012-06-22T00:00:00Z

Document:
Angelia M. Anderson v. United States of America, Misc. No. 14, September Term, 2011.  
STATUTORY INTERPRETATION - MARYLAND MEDICAL MALPRACTICE CLAIMS
STATUTE - STATUTE OF LIMITATION - Maryland Code (1973, 2006 Repl. Vol.) Courts
& Judicial Proceedings Article, § 5-109(a)(1) is a statute of limitations, rather than a statute
of repose, based on its plain language, as confirmed by its legislative history indicating that
the Maryland General Assembly did not intend to create, in enacting § 5-109(a)(1), an
absolute time bar or a grant of immunity for potential defendants in medical malpractice
claims.
United States Court of Appeals for the Fourth Circuit
Case No. 10-1597
IN THE COURT OF APPEALS
OF MARYLAND
Misc. No. 14 
September Term, 2011
                                                                             
ANGELIA M. ANDERSON
v.
UNITED STATES OF AMERICA
                                                                             
 
Bell, C.J.,
Harrell
Battaglia
Greene
Adkins
Barbera 
McDonald,
JJ.
                                                                             
Opinion by Harrell, J.
                                                                             
Filed:   June 22, 2012
1  The Federal Tort Claims Act waives sovereign immunity of the United States for
certain torts committed by federal government employees.  Kerns v. United States, 585
F.3d 187, 194 (4th Cir. 2009) (citing Fed. Deposit Ins. Corp. v. Meyer, 510 U.S. 471, 475,
114 S. Ct. 996, 1000, 127 L. Ed. 2d 308, 316 (1994)).  
“What’s in a name?  That which we call a rose by any other name would smell as
sweet.”  Romeo and Juliet, William Shakespeare.  For most plaintiffs in medical malpractice
actions in our State courts, it would not matter whether we denominate Maryland Code
(1973, 2006 Repl. Vol.) Courts & Judicial Proceedings Article, § 5-109(a)(1) (addressed to
the time within which a medical malpractice claim must be commenced) a statute of
limitation or a statute of repose.  The time period allowed for bringing a medical malpractice
action under § 5-109(a)(1) is five years from the time the injury was committed, after which,
the claim is barred by the passage of the time period.  Thus, in a typical situation governed
by Maryland law, once five years passes after the plaintiff’s alleged injuries (subject to
express tolling situations regarding the age of a claimant), the claim is barred whether the
statute is considered one of repose or limitation. 
In the unusual scenario in the present case underlying the Certified Question of Law
from the federal Court of Appeals for the Fourth Circuit, the label we shall place on the
statute is more than an academic exercise.  The answer to that query determines whether
Appellant Angelia Anderson’s claim against the United States of America may proceed or
is barred.  Anderson brought a medical malpractice action in the United States District Court
for the District of Maryland against the United States under the Federal Tort Claims Act
(“FTCA”).1  The FTCA permits a plaintiff to maintain an action against the federal
government if that person would have a cause of action under state law against a private
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person under similar conditions.  See 28 U.S.C. § 2677 (2012).  The FTCA contains a two-
year statute of limitations regarding the timeliness of bringing claims against the government;
however, if there is substantive law in the state where the claim arose governing the
timeliness of a similar claim, the state provision controls over the FTCA’s statute of
limitations.  Miller v. United States, 932 F.2d 301, 303 (4th Cir. 1991).  Ordinarily under the
FTCA, a state statute of limitations is considered to be a procedural control that limits an
available remedy.  See First United Methodist Church of Hyattsville v. U.S. Gypsum Co., 882
F.2d 862, 865 (4th Cir. 1989).  A state statute of repose, which regulates also the timeliness
of claims, however, is considered substantive law and prevails over the procedural FTCA
statute of limitations.  First United, 882 F.2d at 866.  Thus, if we declare § 5-109(a)(1) to be
a statute of repose, application of its substantive provisions determine the timeliness of
Anderson’s action.  For reasons to be explained, we hold that the plain language of § 5-
109(a)(1), confirmed by its legislative history, demonstrates that § 5-109(a)(1) is a statute of
limitations, rather than repose.  
I.  FACTUAL AND LEGAL BACKGROUND
This case reaches us as a certified question of law from the Federal Court and,
therefore, we are constrained in deciding the question by the facts provided in the
Certification Order.  Md. Code (1973, 2006 Repl. Vol.) Cts. & Jud. Proc. Art., § 12-606; see
also Guttman v. Wells Fargo Bank, 421 Md. 227, 230, 26 A.3d 856, 858 (2011) (citing
Piselli v. 75th St. Med., P.A., 371 Md. 188, 202, 808 A.2d 508, 516 (2002)).  The following
factual statement appears in the Certification Order from the federal appellate court: 
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Anderson first visited the VA Hospital [in Baltimore,
Maryland] in February 2002, complaining of lower back pain.
An MRI revealed scattered bone abnormalities in Anderson’s
lumbar spine and a radiologist recommended a bone scan, which
was performed in May 2002 and showed abnormal results.
Subsequently, a bone marrow biopsy was performed, resulting
in a diagnosis of B-cell lymphoproliferative disease in
Anderson’s spine. Anderson was scheduled to begin
chemotherapy in August 2002, but her doctors determined
instead that a course of observation was more appropriate.
Anderson was given a fentanyl patch to control her pain.
Anderson returned to the VA Hospital in September 2002,
reporting continuing pain on her left side; her doctors responded
by increasing her pain medication.  
On December 19, 2002, Anderson complained at the VA
Hospital of increased pain and new symptoms, including pain
and numbness radiating to her foot.  She was discharged and
instructed to report to the neurology clinic four days later.
Anderson returned to the VA Hospital the next day complaining
of increased pain in her back and an inability to move her legs.
An MRI revealed no evidence of compression.  Anderson again
returned to the VA Hospital on December 23, reporting an
inability to walk or stand and complaining of numbness up to
her breasts.  She was again discharged with instructions to return
for another MRI on December 26.  Anderson instead sought
treatment at another hospital on December 24, where a physical
examination and diagnostic tests revealed an epidural spinal
tumor compressing her spinal cord.  Anderson underwent
immediate surgery to relieve the spinal compression and
remained hospitalized until December 30.
Nearly a year later, on December 17, 2003, Anderson
initiated an administrative claim with Veterans Administration
in Baltimore by filing a completed Standard Form 95 (Claim for
Damage, Injury, or Death).  She alleged that the VA Hospital
failed to recognize the symptoms of progressive spinal cord
compression due to an epidural spine tumor that developed as a
result of her known cancer.  She also alleged that the negligent
care she received at the VA Hospital necessitated emergency
surgery on her spine, and that, notwithstanding the emergency
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surgery, the VA Hospital’s negligence left her with significant,
permanent neurological deficits, severe and permanent
disability, and incessant pain and emotional anguish.  
For nearly four years, Anderson’s claim proceeded
through the administrative process, including significant
settlement discussion, until it was denied as not amendable to
administrative resolution by letter dated September 26, 2007.
Anderson filed suit in the district court on January 2, 2008.  The
government moved to dismiss arguing that Anderson had failed
to file a claim and an expert certificate with the Maryland Health
Care Alternative Dispute Resolution Office (“HCADRO”), as
required by Maryland’s Health Care Malpractice Claims Act
(codified at Md. Code Ann., Cts. & Jud. Proc. § 3-2A-04).  The
district court stayed the case to allow Anderson to file the
complaint and certificate with the HCADRO.  Anderson
complied and the district court lifted the stay.
 The government then filed a second motion to dismiss,
arguing that Section 5-109(a)(1), which it characterized as
Maryland’s statute of repose for health care malpractice claims,
divested the court of subject matter jurisdiction because
Anderson did not file her federal suit within the five-year
statutory period.  In its order granting the motion, the district
court noted that Maryland courts have referred to Section 5-109
as a statute of limitations and that it contains tolling provisions
that are generally inconsistent with statutes of repose.  However,
the district court concluded that, “particularly in light of the
recent reference by the Court of Appeals in Burnside[ v. Wong,
412 Md. 80, 986 A.2d 437 (2010)],” it was “constrained to
conclude that the state’s highest court views § 5-109(a)(1) as a
statute of repose.” [Anderson v. United States, 2010 U.S. Dist.
LEXIS 30759, *11 (D. Md. 2010)] (citing Burnside, 986 A.2d
at 440).  Thus, the district court granted the government’s
motion to dismiss for lack of subject matter jurisdiction.
The district court denied Anderson’s subsequent motion
for reconsideration, and Anderson timely appealed to this Court,
assigning error to the district court’s conclusion that Section 5-
109(a)(1) is a statute of repose.1
                                
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1 Anderson also argues on appeal that the district court
erred by failing to find (1) that participation in the
mandatory administrative procedures required by the
FTCA tolls the running of the statutory period prescribed
by Section 5-109 until the administrative process is
exhausted, and (2) that the filing of a claims notice under
the FTCA satisfies the requirement under Section 5-109
that an action for damages be filed within five years of
the time the injury was committed.  We do not certify
these latter two questions.
Based on these facts, the question certified by the Fourth Circuit, and accepted by this Court,
for consideration is:  
Does Section 5-109(a)(1) of the Courts and Judicial Proceedings
Article of the Maryland Code constitute a statute of limitations
or a statute of repose?
We hold that Courts and Judicial Proceedings Article § 5-109(a)(1) is a statute of limitations,
rather than one of repose. The plain language of the statute indicates to us, and its legislative
history confirms, that the Maryland General Assembly did not intend, by its adoption, to
create an absolute time bar or a grant of immunity for potential defendants in medical
malpractice claims.  
II.  OUR ANALYSIS
A.  The History and Judicial Interpretation of § 5-109
As noted by the Fourth Circuit in its Certification Order, our prior decisions
sometimes refer to § 5-109 as a statute of limitations and other times as a statute of repose.
2  Hector Peabody was the cartoon dog in the “Peabody’s Improbable History”
segments of the “Rocky and His Friends” & “Bullwinkle” television shows that ran
originally in the late 1950s and early 1960s.  Mr. Peabody (and his adopted boy,
Sherman) would travel in his time machine to investigate and explore figures and events
of the Earth’s history.  
-6-
In order to answer the Certified Question, we step into Mr. Peabody’s time machine2 to
explore the history of the statute and clarify our sometimes confusing declarations
characterizing the statute both ways.
The original version of the Maryland Health Care Malpractice Claims statute was
enacted in 1975 in response to a perceived crisis in Maryland in the medical malpractice
insurance industry.  See Chapter 545 of the Acts of 1975; Att’y Gen. of Md. v. Johnson, 282
Md. 274, 385 A.2d 57 (1978).  Section 5-109 was added to the Courts Article “[f]or the
purpose of providing the statute of limitations for actions based on malpractice by
physicians.”  Ch. 545 of the Acts of 1975 (emphasis added).  As enacted originally, § 5-109
read:
An action for damages for an injury arising out of the
rendering of or failure to render professional services by a
physician shall be filed (1) within five years of the time the
injury was committed or (2) within three years of the date when
the injury was discovered, whichever is the shorter.  In no event
shall this time run against a minor until he has attained majority.
Section 5-109 was amended a year later based on recommendations from the Medical
Malpractice Insurance Study Committee, which was comprised of legislators; a
representative for the Governor; and members of medical, legal, hospital, and insurance
interests.  Glenn v. Morelos, 79 Md. App. 90, 92-93, 555 A.2d 1064, 1066 (1989).  The
3 The long “tail” of liability in medical malpractice claims refers to the potential
time lag between treatment (the allegedly negligent act or omission) by a health care
provider and the injury or discovery of an injury by a potential plaintiff.  
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Committee expressed concern about the narrowness of the 1975 version of § 5-109 because
it applied only to physicians rather than to a broader class of health care providers, and also
that, because the section did not apply to minors, there was a potential for a long “tail”3 of
liability.  Glenn, 79 Md. App. at 93, 555 A.2d at 166 (citing Issue Report of the Legislative
Study Group, 1 (February 18, 1976) (statement of Delegate Martin S. Becker, Chairman of
the Committee)). The amendments proposed as the result of the Committee’s
recommendations changed the statutory reference to “physician” to “a health care provider,
as defined in § 3-2A-01 of this article” and replaced the last sentence of § 5-109 with “If the
claimant was under 16 years of age at the time the injury was committed, the time shall
commence when he reaches the age of 16.”  Ch. 235 of the Acts of 1976.  Also added was
the sentence, “Filing of a claim with the Health Claims Arbitration Office in accordance with
§ 3-2A-04 of this article shall be deemed the filing of an action for purposes of this section.”
Id.
In 1985, this Court was presented with a constitutional challenge to § 5-109, which
necessitated consideration of whether the “continuous course of medical treatment” doctrine
applied to application of the statute and also when the statute of limitation begins to run.  Hill
v. Fitzgerald, 304 Md. 689, 692, 501 A.2d 27, 28 (1985).  To determine what triggered the
statute of limitation in § 5-109 in Hill, the Court plumbed the meaning of “medical injury”
-8-
under the Health Care Malpractice Claims Act (“HCMCA”).  Hill, 304 Md. at 694, 501 A.2d
at 29 (citing Oxtoby v. McGowan, 294 Md. 83, 447 A.2d 860 (1982)).  We concluded that,
when enacting the HCMCA, the “General Assembly obviously was not concerned with
invasions of a legally protected interest which do not cause harm in the sense of loss or
detriment in fact . . . .  The Act is concerned with the invasion of legally protected interests
coupled with harm.”  Hill, 304 Md. at 695, 501 A.2d at 30 (quoting Oxtoby, 294 Md. at 93-
94, 447 A.2d at 860) (internal quotations omitted).  We synthesized the relevant holding of
Oxtoby as “all that is required is that the negligent act be coupled with some harm in order
for a legally cognizable wrong – and, therefore, injury – to have occurred.” Hill, 304 Md. at
696, 501 A.2d at 30 (citing Oxtoby, 294 Md. at 94, 447 A.2d at 860).  Although Oxtoby dealt
with “medical injury” under the HCMCA and Hill addressed “injury” under § 5-109, the
Court concluded nevertheless that “the legislature . . . intended no substantive distinction in
the legal application of the two terms.”  Hill, 304 Md. at 696-97, 501 A.2d at 30.  Thus, the
limitations periods in § 5-109 are triggered by “injuries which arise out of the rendering of
or failure to render professional services by a health care provider,” coupled with a legally
cognizable harm.  Id.  (internal quotations omitted).  
In concluding that § 5-109 abrogated the common law “continuing treatment” rule,
the Hill court looked to the legislative purpose of the statute.  The Court explained that 
the words of § 5-109 expressly place an absolute period of
limitation on medical malpractice claims calculated on the basis
of when the injury was committed, i.e., the date upon which the
allegedly negligent act was first coupled with the harm.  The
purpose of the statute, readily evident from its terms, was to
4  Article 19 of the Maryland Declaration of Rights states: 
That every man, for any injury done to him in his
person or property, ought to have remedy by the course of the
Law of the Land, and ought to have justice and right, freely
without sale, fully without any denial, and speedily without
delay, according to the Law of the Land.
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contain the “long-tail” effect of the discovery rule in medical
malpractice cases, by restricting, in absolute terms, the amount
of time that could lapse between the allegedly negligent
treatment of a patient and the filing of a malpractice claim
related to that treatment.
Hill, 304 Md. at 699-700, 501 A.2d at 32.  Although the statute contained an explicit tolling
exception for minority, the Hill court concluded that there was no room for implied
exceptions because the Legislature enacted the statute in response to the “so-called crisis in
the field of medical malpractice claims.”  Hill, 304 Md. at 700, 501 A.2d at 32.  In this same
vein of reasoning, the Court concluded that the time periods in § 5-109 must “be calculated
in accordance with the literal language” of the statute.  Id.  The five-year time bar in the
statute at that time operated without regard to whether an injury was discoverable readily.
Id.  Because § 5-109 was concerned with when the injury was committed, and not when the
treatment was concluded finally, the common law “continuous treatment” rule was
abrogated.  Hill, 304 Md. at 700, 501 A.2d at 32.  
Hill challenged the constitutionality of § 5-109 by alleging that its denial of access to
the courts amounted to destruction of his rights in violation of Article 19 of the Maryland
Declaration of Rights.4  Hill, 304 Md. at 700, 501 A.2d at 33.  In resolving that § 5-109 was
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constitutional, the Court in Hill considered the reasonableness of the statute’s denial of
access to the courts by looking to other cases where statutes of limitations were challenged.
304 Md. at 702, 501 A.2d at 34.  The Court concluded that, by imposing an absolute five-
year time bar, the Legislature struck a fair balance that furthered the legitimate State purpose
of maintaining control of medical malpractice insurance rates and the continuing availability
of such coverage, and, at the same time, “affording protection to individuals who sustain
injuries by reason of medical malpractice.”  Id.  The Court considered also that in 1867, when
Article 19 was adopted, the prevailing law dictated that a right or cause of action was
generated from an alleged wrong, and statutes of limitation were measured from the date of
the wrong.  Hill, 304 Md. at 704, 501 A.2d at 35 (citing Goldstein v. Potomac Elec. Power
Co., 285 Md. 673, 404 A.2d 1064 (1979); Waldman v. Rohrbaugh, 241 Md. 137, 139, 215
A.2d 825, 827 (1966)).  It was not until 1917 that the discovery rule was adopted for medical
malpractice cases, thus changing the triggering event (and thus the time) from which the
statute of limitations began to run.  Id.  (citing Hahn v. Claybrook, 130 Md. 179, 100 A. 83
(1917)).  The Court concluded that the limitation period in § 5-109 was a reasonable
restriction on access to the courts.  Id.
Section 5-109 was amended again in 1987, partly in response to this Court’s decision
in Hill.  The relevant portion of the Senate Bill 225 of 1987, as introduced, read:
(a) Limitations. -- An action for damages for an injury arising
out of the rendering of or failure to render professional services
by a health care provider, as defined in §§ 3-2A-01 of this
article, shall be filed within the earlier of:
5  Although not dispositive of the question before us, we note the difference in the
language of the summary of legislation in the fiscal notes for the proposed bill and the
enrolled bill.  The purpose of the proposed bill, which changed the “injury was
committed” language to “the allegedly wrongful act or omission,” was summarized in the
initial version of the fiscal note as an “administration bill [that provides that] an action for
damages in a medical malpractice suit must be filed within five years of the allegedly
wrongful act or omission, or within three years of the date when the injury was
discovered, whichever is shorter.”  The summary of the enrolled bill, in contrast, states
that “[t]his enrolled bill establishes a general statute of limitations for an action to be filed
for damages in a medical malpractice claim to be the earlier of 5 years from the time the
injury is committed, or 3 years of the date the injury is discovered.”
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(1) Five years of the allegedly wrongful act or omission . . . .
(Emphasis added.)  The Governor, through his Legislative Office, was concerned that the
Hill court’s interpretation of “injury,” as meaning “the date that the allegedly negligent act
was first coupled with harm,” was too expansive.  Governor’s Legislative Office, Briefing
Paper, H.B. 245/S.B. 225, at 3 (1987). The concern was explicated as
it would be possible under this interpretation to bring an action
for a harm that had not manifested itself for years after the
negligent act.  In some cases, this interpretation effectively
negates the limitations period.  Such unexpected expansions of
risk exposure diminish predictability and pricing stability and,
generally, contribute to the soaring premiums in the Maryland
malpractice insurance marketplace. 
Id.  The provision in the proposed bill abrogating the decision in Hill, substituting “allegedly
wrongful act or omission” for “the injury was committed,” was deleted from the bill by
amendment before passage; thus, the ultimate language of the enacted statute did not change
our interpretation of “injury.”5  See Senate Judicial Proceedings Committee, Summary of
Committee Report, S.B. 225 (1987).  The 1987 amendments to § 5-109 added explicit
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provisions allowing for § 5-201 (tolling the limitation period for persons under a disability)
and § 5-203 (tolling the limitation period for fraud) to apply to medical malpractice actions.
Ch. 592 of the Acts of 1987.  After the 1987 amendments, and as it exists today, § 5-109(a)
reads:
(a) Limitations – An action for damages for an injury arising out
of the rendering of or failure to render professional services by
a health care provider, as defined in § 3-2A-01 of this article,
shall be filed within the earlier of:
(1) Five years of the time the injury was committed; or
(2) Three years of the date the injury was discovered.
In Jones v. Speed, 320 Md. 249, 253, 577 A.2d 64, 66 (1990), we affirmed once again
the constitutionality of § 5-109 (with its 1987 amendments) in our answer to a question
similar to the one posed in Hill.  Elizabeth Jones suffered from chronic headaches.  Jones,
320 Md. at 254, 577 A.2d at 66.  She sought treatment from Dr. Speed in July of 1978.  Id.
Dr. Speed treated Jones for the headaches until February 1986, but did not order a CAT scan
during any visit, despite requests from Jones for such scans.  Id.  In February 1986, Jones,
after suffering a seizure, was diagnosed with a brain tumor.  Id.  Jones argued that each
individual medical appointment with Dr. Speed, where he failed to order the proper
diagnostic tests, was a separate act of negligence, rather than a continuing course of
treatment.  Id.  Therefore, her more recent appointments with Dr. Speed, which fell within
the five-year window preceding filing formally her claim, were sufficient to satisfy the
statute.  Jones, 320 Md. at 256, 577 A.2d at 67.  The Court agreed with Jones and concluded
that she was permitted to split her claim in such a way as to allow her to pursue allegations
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of negligence against Dr. Speed that were related to appointments that occurred within the
pertinent five year time period.  Jones, 320 Md. at 261, 577 A.2d at 70.  The Court reached
this conclusion despite Dr. Speed’s protestation that “acceptance of the plaintiffs’ theory
would frustrate the legislative intent to provide absolute protection to health care providers
for acts of negligence occurring more than five years before the bringing of an action.”
Jones, 320 Md. at 257, 577 A.2d at 67 (emphasis added).  The Court responded that
“plaintiffs . . . will be entitled to recover damages only for acts of negligence occurring
within five years of the filing of their claim,” an interpretation that does not “offend the
language or the spirit” of § 5-109.  Jones, 320 Md. at 257, 260, 577 A.2d at 67, 69.
It was not until Newell v. Richards that it appears to us that we first referred, in an
opinion of the Court, to § 5-109 as a “special statute of repose,” rather than a statute of
limitations.  323 Md. 717, 724, 594 A.2d 1152, 1156 (1991).  The question in Newell was
which party in such an action bears the burden of proving that the three-year “discovery”
provision in § 5-109(a)(2) did not bar a claim brought within the five-year limitation period
in § 5-109(a)(1).  Id.  Analyzing the statute, the Court noted that
[f]rom the plain language of the statute, it is not clear whether
the General Assembly intended § 5-109 to be either (A) a five-
year statute of repose with a provision that allows a defendant
to cut that period short by up to two years if the defendant can
show that the plaintiff did not comply with the three-year
discovery provision, or (B) a three-year statute of limitations
with a provision that could allow the plaintiff to extend that
period up to five years if the plaintiff can show that he or she
filed the claim within the three-year discovery provision.
Newell, 323 Md. at 725, 594 A.2d at 1157.  The Court in Newell looked to Hill for guidance,
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concluding that the General Assembly intended § 5-109 to curtail the common law discovery
rule and bar any claim, discoverable or not, after five years, with the objective of promoting
“society’s interest in maintaining malpractice insurance coverage and managing the costs of
malpractice litigation.”  Newell, 323 Md. at 727-28, 594 A.2d at 1157.  The Court concluded
that, because the Legislature intended § 5-109 to “create a total bar to malpractice actions
brought after five years from the date of the alleged negligent treatment,” the medical
provider bore the burden of proof to show whether a claimant’s action falls under § 5-
109(a)(1) or (2).  Newell, 323 Md. at 728, 594 A.2d at 1157-68.  
The Court of Special Appeals (“COSA”), in Edmonds v. Cytology Services of
Maryland, Inc., 111 Md. App. 233, 681 A.2d 546 (1996), discussed  in depth the application
of § 5-109.  In 1980, Debra Edmonds sought treatment from a gynecologist, Dr. Murgalo,
for cervical problems.  Edmonds, 111 Md. App. at 236, 681 A.2d at 547.  After three years
of various treatments, Edmonds was diagnosed with cervical cancer.  Edmonds, 111 Md.
App. at 237, 681 A.2d at 548.  Dr. Murgalo conducted a procedure to treat the cancer.
Edmonds, 111 Md. App. at 238, 681 A.2d at 548. A biopsy of Edmond’s cervix from that
procedure indicated that “[a]ll margins are free - 5.”  Id.  No further treatment was given to
Edmonds for the cancer.  Id.  She underwent subsequent Pap smears over the next five years,
with no abnormal results.  Id.  In 1989, Edmonds complained of severe back pain and was
referred to an orthopedist who treated her, without positive results.  Id.  Later that year, a
tumor was discovered in Edmond’s abdomen and, despite treatment, she died on 5 April
1990.  Edmonds, 111 Md. App. at 240, 681 A.2d at 549.  Her relatives filed wrongful death
6  The California medical malpractice claims statute provides, in relevant part:
In an action for injury or death against a health care
provider based upon such person’s alleged professional
negligence, the time for the commencement of action shall be
three years after the date of injury or one year after the
plaintiff discovers, or through the use of reasonable diligence
should have discovered, the injury, whichever occurs first.  In
no event shall the time for commencement of legal action
(continued...)
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and survival actions against the pathologist and other doctors for failing negligently to
diagnose earlier her invasive cervical cancer.  Id.  The doctors asserted that Edmond’s claims
were time barred by § 5-109(a).  Edmonds, 111 Md. App. at 242, 681 A.2d at 550.
The intermediate appellate court looked to the history of the statute and this Court’s
past opinions to determine when Edmonds suffered an actionable “injury.”  Edmonds, 111
Md. App. at 246, 681 A.2d at 552.  Edmonds’s relatives argued that the trial court erred when
it determined, as a matter of law, that her “injury” occurred in 1983 with the misdiagnosis
of the pathology sample.  Id.  They asserted that she did not suffer any “discernible effect”
from the undiscovered disease until 1988 when she experienced back pain, and that was the
time when the doctor’s negligence harmed or “injured” Edmonds.  Id.  The COSA looked to
other jurisdictions with medical malpractice claims statutes of limitation similar to
Maryland’s to determine when an “injury” occurs.  Edmonds, 111 Md. App. at 247, 681 A.2d
at 553.
The Edmonds court rejected the California view that “injury” occurs when the patient
discovers the harm because this would embrace essentially the discovery rule, which had
been rejected by enaction of § 5-109.6  Edmonds, 111 Md. App. at 250-51, 681 A.2d at 554.
6(...continued)
exceed three years unless tolled for [fraud, intentional
concealment, or the presences of an unauthorized foreign
body in the patient].
Edmonds v. Cytology Servs. of Md., Inc., 111 Md. App. 233, 248, 681 A.2d 546, 553
(1996) (citing Cal. Code § 340.5 (1996)).  
7  Delaware’s medical malpractice claims statute of limitation states, in relevant
part:
No action for the recovery of damages upon a claim
against a health care provider for personal injury, including
person injury . . . arising out of malpractice shall be brought
after the expiration of 2 years from the date upon which such
injury occurred . . . .
Edmonds, 111 Md. App. at 255, 681 A.2d at 557 (citing Del. Code. Ann. tit. 18, § 6856
(1989).
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The California view, applied to § 5-109, would also “render meaningless the dichotomy
between C.J. § 5-109(a)(1) and C.J. § 5-109(a)(2),” and be contrary to this Court’s statement
in Hill that § 5-109(a)(1) runs “without regard to whether the injury was reasonably
discoverable.”  Edmonds, 111 Md. App. at 251, 681 A.2d at 554-55.  The COSA rejected
also Delaware’s view that “injury” occurs at the time of the wrongful act or omission.7
Edmonds, 111 Md. App. at 255, 681 A.2d at 557.  In rejecting Delaware’s approach, the
intermediate appellate court opined that Maryland could have followed, but did not, the
majority of jurisdictions with medical malpractice claims statutes of limitations that
commence upon the occurrence of the negligent act or omission.  Id.  In fact, the Maryland
General Assembly rejected an attempt to bring its medical malpractice claims statute of
limitation more in line with these other jurisdictions in 1987.  Id.  Noting the stated purpose
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of the 1987 rejected amendments to S.B. 225, “to overturn the decision of the Court of
Appeals in Hill,” the intermediate appellate court concluded that “[t]his history provides
strong evidence that the General Assembly did not intend to create an ironclad rule that a
medical malpractice claim would be barred if filed more than five years after the health care
provider’s act.” Edmonds, 111 Md. App. at 256, 681 A.2d at 557.  The court discerned that
the General Assembly, concerned with the competing interests of patients who suffered
medical malpractice and the public interest in keeping malpractice insurance rates low,
struck a balance by “providing that the five year ‘cutoff’ period in C.J. § 5-109(a)(1) would
begin to run on the date when the ‘injury’ resulting from the health care provider’s wrongful
act or omission occurred, rather than from the date of that act or omission.”  Edmonds, 111
Md. App. at 257, 681 A.2d at 557-58.  Reiterating the holdings of Hill and Oxtoby, the
COSA stated that an “injury” occurs when a patient suffers a legally cognizable harm.
Edmonds, 111 Md. App. at 259, 681 A.2d at 558.
The Edmonds court noted also the comparison to Courts and Judicial Proceedings
Article § 5-108(b), a generally accepted statute of repose, to show that the General Assembly
was cognizant of how to create a statute where the limitations period was triggered by a
negligent act or omission, rather than an “injury.”  Edmonds, 111 Md. App. at 268-69, 681
A.2d at 563.  This Court affirmed Edmonds in Rivera v. Edmonds, 347 Md. 208, 209, 699
A.2d 1194, 1195 (1997), but, in doing so, referred notably to § 5-109 as a statute of repose.
In Piselli, 371 Md. at 193, 808 A.2d at 510, we pondered, in the context of another
certified question of law from the Fourth Circuit, whether the three-year time limit of § 5-
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109(a)(2) begins to accrue when a minor child discovers an injury or when the parents of the
child discover the injury.  We determined that the child’s claim did not accrue until he
reached the age of majority, and in reaching that epiphany, looked to the legislative history
of the medical malpractice claims statute to determine its proper effect.  Piselli, 371 Md. at
203, 808 A.2d at 517.  This Court concluded that § 5-109(a)(2) reflects Maryland’s
traditional discovery rule.  Id.  In determining the reasonableness of restrictions on access to
the courts, we considered our previous opinions upholding “the five-year statute of repose
for medical malpractice actions set forth in § 5-109(a) and the 10 and 20-year statutes of
repose for actions based on defective conditions in real property set forth in § 5-108.”
Piselli, 371 Md. at 207-08, 808 A.2d at 519 (citing Hill, 304 Md. at 703-05, 501 A.2d at 34-
35; Whiting-Turner Contracting Co. v. Coupard, 304 Md. 340, 359-60, 499 A.2d 178, 188-
89 (1985)).  We noted that even our characterization of these statutes as strict repose periods
did not create unreasonable restrictions upon remedies or access to the courts, as applied to
adult plaintiffs.  Piselli, 371 Md. at 208, 80 A.2d at 519.  Thus, the restriction of  access to
the courts in § 5-109 was upheld as reasonable.  Id.  
Most recently, in Burnside, 412 Md. at 184, 986 A.2d at 429, we discussed the term
“injury” in the context of determining the proper venue for a medical malpractice action.  In
discussing Jones, we referred to § 5-109 as a statute of limitations, but in discussing
Edmonds, also referred to the statute as one of repose.  Burnside, 412 Md. at 203-04, 986
A.2d at 440.  This seems to be the “last straw” that triggered the certification of the question
propounded by the federal court here.  The proper classification of § 5-109 in Burnside,
8  In the 5th Edition of Black’s Law Dictionary (1979), the definition of statute of
repose was “a legislative act whereby the state declares that after lapse of a specified
time, a claim shall no longer be enforceable in a judicial proceeding.”  This definition is
almost identical to that of a statute of limitation and, while this was superceded by more
modern distinctions between the two types of statutes, we note this as a possible
contributor to confusion in our opinions until 1994, when the Sixth Edition was published
with the same definitions as appear in the 2009 - 9th Edition.  
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however, was not a material factor bearing on the outcome of the case.  
B.  What Distinguishes a Statute of Limitation from a Statute of Repose?
There is an abundance of scholarly commentary aimed at clarifying the differences
between statutes of limitation and statutes of repose.  We shall begin with the basics.  Black’s
Law Dictionary defines “statute of limitations” as a “law that bars claims after a specified
period . . . a statute establishing a time limit for suing in a civil case, based on the date when
the claim accrued (as when the injury occurred or was discovered).”  Black’s Law Dictionary
1546 (9th ed. 2009).  A statute of repose is defined as a “statute barring any suit that is
brought after a specified time since the defendant acted (such as by designing or
manufacturing a product), even if this period ends before the plaintiff has suffered a resulting
injury.”8  Id.  
Statutes of limitations are enacted typically to encourage prompt resolution of claims,
to suppress stale claims, and to avoid the problems associated with extended delays in
bringing a cause of action, including missing witnesses, faded memories, and the loss of
evidence.  See Harig v. Johns-Manville Prods. Corp., 284 Md. 70, 75, 394 A.2d 299, 302
(1987)).  Statutes of limitations promote judicial economy and fairness, but do not create any
substantive rights in a defendant to be free from liability.  First United, 882 F.2d at 865.  A
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statute of limitations is typically triggered by the accrual of a claim.  Am. Gen. Assur. Co. v.
Pappano, 374 Md. 339, 351, 822 A.2d 1212, 1219 (2003).  Tolling, typically for reasons of
fraudulent concealment or minority, is applicable generally to statutes of limitation.  First
United, 882 F.2d at 866.
The label of statute of repose is used generally to describe a statute which shelters
legislatively-designated groups from an action after a certain period of time. Susan C.
Randall, Due Process Challenges to Statutes of Repose, 40 Sw. L.J. 997, 998 (1986).  Statute
of repose, as that term is used commonly, refers to a special statute with a different purpose
and implementation than a statute of limitation.  Randall, supra, at 1002.  The purpose of a
statute of repose is to provide an absolute bar to an action or to provide a grant of immunity
to a class of potential defendants after a designated time period.  Francis E. McGovern, The
Variety, Policy and Constitutionality of Product Liability Statutes of Repose, 30 Am. U. L.
Rev. 579, 585 (1980); see also First United, 882 F.2d at 866.  Statues of repose differ from
statutes of limitation in that the trigger for a statute of repose period is unrelated to when the
injury or discovery of the injury occurs.  First United, 882 F.2d at 866.  Statues of repose run
from an event that is unrelated to when the injury occurs.  Id; see also McGovern, supra, at
585.  Thus, a statute of repose may extinguish a potential plaintiff’s right to bring a claim
before the cause of action accrues.  Randall, supra, at 1004-05.  In common parlance, statutes
of limitation and statues of repose are differentiated consistently and confidently by whether
the triggering event is an injury or an unrelated event; the latter applying to a statute of
repose.  Daniel J. La Fave, Article: Remedying the Confusion Between Statutes of Limitations
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and Statutes of Repose in Wisconsin - A Conceptual Guide, 88 Marq. L. Rev. 927, 928
(2005).
Numerous courts have also held that statutes of repose are characterized by a trigger
that starts the statutory clock running for when an action may be brought based on some
event, act, or omission that is unrelated to the occurrence of the plaintiff’s injury.  See
McCann v. Hy-Vee, Inc., 663 F.3d 926, 931 (7th Cir. 2011) (“[T]here is no tort without an
injury and if the period in which a tort suit can be brought runs from the date of the tort, it
is a period prescribed by a statute of limitations rather than by a statute of repose”); Hoffner
v. Johnson, 660 N.W.2d 909, 913-15 (N.D. 2003) (explaining that a statute of repose “begins
to run from the occurrence of some event other than the event of an injury that gives rise to
a cause of action and, therefore, bars a cause of action before the injury occurs”); Combs v.
Int’l Ins. Co., 354 F.3d 568, 590 n.11 (6th Cir. 2004) (“A statute of limitations focuses on
time measured from an injury; a statute of repose rests on the time from some initiating event
unrelated to an injury.”); Clark Cnty. v. Sioux Equip. Corp., 753 N.W.2d 406, 415 n.6 (S.D.
2008) (explaining that a statue of repose “begins to run from a date that is unrelated to the
date of an injury”).  
Opinions of this Court and the federal courts have considered the difference between
a statute of repose and a statute of limitation.  If a reliable distinction between statutes of
limitation and statutes of repose existed prior to 1994, we muddied the waters in Hecht v.
Resolution Trust Corporation, 333 Md. 324, 635 A.2d 394 (1994).  There, we stated that
“[s]tatutes of limitation are statutes of repose, allowing individuals the ability to plan for the
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future,” designed to ensure fairness to defendants through prompt resolution of claims and
to avoid “problems that may stem from delay, such as loss of evidence, fading of memory,
and disappearance of witnesses.”  Hecht, 333 Md. at 333, 635 A.2d at 399.  In Hecht, we set
forth a standard of strict construction regarding tolling of statutes of limitations, concluding
that, absent legislative creation of an exception to the statute of limitations, we will not allow
any “implied and equitable exception to be engrafted upon it.”  Id.  In hindsight, although the
unfortunate conflation of statutes of limitation and statutes of repose does appear briefly in
Hecht, the explanation accompanying that statement is quintessentially an accurate
description of the purposes of a statute of limitation.
The distinction between statutes of limitations and repose has been considered also
in the context of Courts and Judicial Proceedings Article § 5-108, which governs professional
liability actions brought against architects, engineers, and contractors.  Section 5-109, the
medical malpractice statute of limitations, has been used sometimes to compare and contrast
the statute of repose contained in § 5-108.  
In First United, an appeal from the district court, deciding whether the repose period
contained within § 5-108 was preempted by the Comprehensive Environmental Response and
Compensation Act, 42 U.S.C. § 9658 (2012), the Fourth Circuit discussed the distinctions
between a statute of repose and a statute of limitations.  First United, 882 F.2d at 864.  The
court explained that a statute of limitation acted as a “defense to limit the remedy available
from an existing cause of action.”  First United, 882 F.2d at 865 (citing Goad v. Celotex
Corp., 831 F.2d 508, 511 (4th Cir. 1987)).  Statutes of limitations are designed to provide
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fairness to defendants and to “encourage prompt resolution of stale claims.”  First United,
882 F.2d at 866 (citing Harig, 284 Md. at 75, 394 A.2d at 302).  Statutes of repose, on the
other hand, create a substantive right protecting a defendant from liability after a
legislatively-determined period of time.  Id.  
When enacting a statute of repose, a legislature balances the economic best interests
of the public against the rights of potential plaintiffs and determines an appropriate period
of time, after which liability no longer exists.  Id.  (citing Whiting-Turner, 304 Md. at 349-50,
499 A.2d at 183).  The court noted that statutes of limitations are tolled often by fraudulent
concealment, but that statutes of repose are not because the latter are an absolute time bar,
after which liability no longer exists, and to toll the repose period would “upset the balance
struck by the legislative body.”  Id.  (citing Knox v. AC & S, Inc., 690 F. Supp. 752, 759
(S.D. Ind. 1988)).  The language of the statute of repose, § 5-108, indicated clearly that the
Legislature intended to tie the accrual of the cause of action to the date of completion of a
particular property improvement because traditional tolling mechanisms expanded the
liability of defendants.  Id.  (citing Whiting-Turner, 304 Md. at 349-50, 499 A.2d at 183). 
The court contrasted the provision in the then extent version of § 5-109 that allowed
specifically for tolling of the limitations period based on fraudulent concealment by applying
Courts and Judicial Proceedings § 5-203.  Id.  Because the General Assembly did not apply
specifically § 5-203, as it did in § 5-109, the court concluded that the statute of repose in §
5-108 did not toll for fraudulent concealment.  Id.
In another case in the United States District Court for the District of Maryland, the
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court relied upon the characterizations in First United to describe the current version of § 5-
109 as a statute of limitation. Streeter v. SSOE Sys., 732 F. Supp. 2d 569, 577 (2010).  The
court based its classification of § 5-109 as a statute of limitation because it is invoked “after
an injury has already occurred and a claim accrued and sets a limit on how long a plaintiff
has to seek a legal remedy for that claim.”  Streeter, 732 F. Supp. 2d at 577.  Thus, the court
concluded, § 5-109 is “simply ‘a procedural device that operates as a defense to limit the
remedy available from an existing cause of action.’” Streeter, 732 F. Supp. 2d at 577
(quoting First United, 882 F.2d at 865).  Rejecting the plaintiff’s characterization of § 5-109
as a statute of repose, the court reasoned that “the difference between a statute of limitations
and statute of repose is that in the former, a cause of action has already accrued and a
limitation is placed on the time an injured individual has to file a claim, and in the latter, a
limitation is placed on the time in which an action may accrue should an injury occur in the
future.”  Streeter, 732 F. Supp. 2d at 577 n.4 (citing First United, 882 F.2d at 865-66).  The
court noted also that § 5-109 may be tolled in order to prevent injustice, a feature
distinguishable from § 5-108, a statute of repose.  Streeter, 732 F. Supp. 2d at 577.    
In Hagerstown Elderly Associates Limited Partnership v. Hagerstown Elderly
Building Associates Limited Partnership, 368 Md. 351, 793 A.2d 579 (2002), we looked in
depth at Maryland’s statute governing the time to bring an action for injuries to persons or
property occurring after completion of an improvement to realty, Courts and Judicial
Proceedings Article § 5-108.  We concluded that § 5-108 contains two statutes of repose, (a)
and (b), and one statute of limitation, (c).  Hagerstown Elderly Assocs. Ltd. P’ship, 368 Md.
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at 358, 793 A.2d at 583.  Subsections (a) and (b) were statutes of repose because they used
the same format and similar language to make clear that “a cause of action for damages does
not accrue and a person may not seek contribution or indemnity” after a fixed time period
“after the date the entire improvement first becomes available for its intended use.”  Id.  In
contrast to subsections (a) and (b), we considered subsection (c) a statute of limitations
because its language made clear that “upon accrual of a cause of action referred to in
subsections (a) and (b), an action shall be filed within three years.”  Id.  The key difference
between the sections was whether accrual of the cause of action was required to trigger the
limitations period.  
C.  Why We Conclude That Courts and Judicial Proceedings 
Article § 5-109(a)(1) is a Statute of Limitation.
The primary argument advanced by Anderson is that, because § 5-109(a)(1) is
triggered by an injury or a legally cognizable event, it must be classified as a statute of
limitation because statues of repose are triggered by an event unrelated to the occurrence of
an injury or the accrual of the plaintiff’s cause of action.  Further, Anderson states that,
because § 5-109(a)(1) requires an injury to become activated, it cannot be a statute of repose
because it fails to immunize a potential health care provider for injuries that have not yet
arisen. Additionally, Anderson reasons, because § 5-109(a)(1) is subject to tolling and
provides no conclusive date at which liability for a health care provider is extinguished, it
cannot be a statute of repose.
The government rests its classification of § 5-109 as a statute of repose primarily on
the fact that § 5-109 was enacted by the Legislature in response to a crisis in the medical
9 We agree, based on our conclusion in Hagerstown Elderly Associates Limited
Partnership v. Hagerstown Elderly Building Associates Limited Partnership that § 5-108
contains within its terms both statutes of limitations and repose, that this same
dichotomous conclusion is at least conceptually available also for § 5-109. 368 Md. 351,
358, 793 A.2d 579, 583 (2002).  Section 5-109(a)(2) is a statute of limitations, according
to the United States here, because “the time period begins to run only after the claim
accrues.”  We find this contention a bit perplexing, however, because the language in
(a)(2), where the claim accrues is “the injury,” is used by (a)(1) as a trigger as well.  
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malpractice insurance industry.  It reasons that, because the statute was designed to balance
the competing public and private rights in the best interest of society, it must be one of
repose.  Thus, the United States urges us, in the present case, to conclude that § 5-109(a)(1)
is a statute of repose and that § 5-109(a)(2) is a statute of limitation.9 
As we discussed earlier in this opinion, there are overlapping features of statutes of
limitations and statutes of repose, and definitions aplenty from which to choose.  There is,
apparently, no hard and fast rule to use as a guide.  For example, tolling applies typically to
statutes of limitations, rather than statutes of repose, but North Dakota’s medical malpractice
claims statute of repose tolls for fraudulent conduct of the physician.  N.D. Cent. Code § 28-
01-18 (3) (2012).  We choose not to rely on any single feature of § 5-109(a)(1) in
determining its proper classification; rather, we look holistically at the statute and its history
to determine whether it is akin to a statute of limitation or a statute of repose.  
As a threshold matter, we disagree with the government’s primary argument that
because the Legislature enacted § 5-109 in response to an economic crisis the statute must
be one of repose.  During the national medical malpractice insurance crisis of the 1970s,
reforms of many stripes swept the country.  Most states enacted some form of medical
10  North Dakota’s statute of repose for malpractice reads, in relevant part: 
The following actions must be commenced within two years
after the claim for relief has accrued: . . . An action for the
recovery of damages resulting from malpractice; provided,
however, that the limitation of an action against a physician or
licenced hospital will not be extended beyond six years of the
act or omission of alleged malpractice by a nondiscovery
therefore unless discovery was prevented by the fraudulent
conduct of the physician or licensed hospital.
N.D. Cent. Code § 28-01-18 (3) (2012).  See Hoffner v. Johnson, 660 N.W.2d 909 (N.D.
2003); Tracy J. Lyson, Case Comment: Constitutional Law – Equal Protection of the
Laws:  The Equal Protection Challenge to the Medical Malpractice Statute of Repose in
North Dakota, 80 N. D. L. Rev. 175 (2004) (classifying North Dakota’s statute as one of
repose).  North Carolina’s malpractice claims statute of repose states, in relevant part: “a
cause of action for malpractice arising out of the performance of or failure to perform
professional services shall be deemed to accrue at the time of the occurrence of the last
act of the defendant giving rise to the cause of action . . . .”  N.C. Gen Stat. § 1-15(c)
(2012).  See Michael John Byrne, Survey of Developments of North Carolina and the
Fourth Circuit, 1994: I: Civil Procedure, 73 N.C. L. Rev. 2209 (1995) (classifying North
Carolina’s statute as one of repose).  Arkansas’s medical malpractice statute of repose
provides, in relevant part: “[t]he date of the  accrual of the cause of action shall be the
date of the wrongful act complained of and no other time.”  Ark. Code. Ann. § 16-114-
203 (2012); See Robert W. George, Prognosis Questionable: An Examination of the
Constitutional Health of the Arkansas Medical Malpractice Statute of Repose, 50 Ark. L.
Rev. 691 (1998) (classifying Arkansas’s malpractice statute as one of repose).  Utah’s
statute addressing the time for bringing a medical malpractice claim contains both a
statute of limitations and repose.  Timothy C. Hale, Development: Recent Developments
in Utah Case Law: The Constitutionality of the Utah Health Care Malpractice Act as
Applied to Minors, 1995 Utah L. Rev. 350 (1995).  The statute provides, in relevant part:
“1) A malpractice action against a health care provider shall be commenced within two
years after the plaintiff or patient discovers, or through the use of reasonable diligence
should have discovered the injury, whichever first occurs, but not to exceed four years
after the date of the alleged act, omission, neglect, or occurrence.” Utah Code Ann. 78B-
(continued...)
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malpractice tort reform and Maryland was among them.  Some states chose to adopt strict
statutes of repose that measured the time for a plaintiff to bring an action from the date of the
allegedly negligent act or omission10 while others chose to adopt a more lenient statute of
10(...continued)
3-404 (2012).  
11  See California’s medical malpractice statute of limitations, discussed supra,
footnote 6.  
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limitation11 that was measured from the date of an injury.  Maryland chose the latter.  
The impetus for the legislative enactment does not dictate alone our reading of § 5-
109.  First and foremost, the plain language of the statute controls.  Our reading of the plain
language leads us to conclude that the Legislature struck a balance between the public
interests of ensuring the continued availability of medical malpractice insurance in the State
and the rights of victims of medical malpractice to initiate a cause of action for five years
after their injury.  The General Assembly was free to choose a different statutory scheme, one
that did not run the limitations period from an injury or toll the period for minority or
otherwise, but it chose not to do so.  It chose, instead, to adopt a statute of limitations.
The General Assembly, although it had many opportunities to put in place a strict
statute of repose, rejected that option outright in 1987.  The Briefing Paper provided to the
General Assembly describing the impact of this Court’s decision in Hill indicated clearly that
the statute, which triggered the limitations period based on injury, could allow potentially for
some long “tail” malpractice claims.  In maintaining § 5-109(a)(1)’s trigger as “the injury,”
the Legislature accepted implicitly the risk implications of long “tail” claims.  
If the Legislature intended § 5-109(a)(1) to be an absolute time bar, it likely would not
have subjected the limitations to explicit tolling for fraudulent concealment and minority.
Further, in our view, the Legislature rejected knowingly the 1987 amendments that would
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have created an absolute time bar by which medical malpractice insurance carriers and health
care providers could have calculated an exact life-span of liability.  Instead, the statute
measures time from the date of an injury.  As we have seen from our previous opinions,
injury may not coincide always with the date of an allegedly wrongful act or omission.
Taken as a whole, the Legislature did not intend to create a strict statute of repose here. 
This conclusion is supported by contrasting § 5-109 to the statutes of repose contained
within § 5-108.  Subsections (a) and (b) of § 5-108 use the explicit edict that a “cause of
action does not accrue” and commences the running of the time period based on the date of
completion of the property improvements.  Section 5-109(a)(1), however, is triggered by the
cause of action itself – the injury.  The time period is not related to an event or action
independent of the potential plaintiff.  In other words, without the plaintiff’s injury (the cause
of action), the limitations period would not commence to run.  The statutes of repose in § 5-
108 demonstrate that, had the General Assembly wished to create an absolute time bar
granting immunity to health care providers, it knew the difference and how to express what
it intended.  The statutes of repose adopted by numerous other states, contemporaneously
with the original enactment of § 5-109, provided a range of language alternatives creating
an absolute time bar.  Maryland did not follow suit.  
In the past, this Court’s opinions have used interchangeably sometimes the descriptors
“repose” and “limitations,” as well as the term “an absolute bar,” to describe § 5-109;
however, a focused critical evaluation of the entire suite of legislative history and judicial
interpretations of the statute demonstrate that “statute of limitations” is the more appropriate
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classification.  Although in Hill we called the statute an “absolute bar,” we set forth in the
next breath the important principle that “injury” occurs when the “allegedly negligent act was
first coupled with harm.”  This principle opens the door for and blesses claims arising from
an allegedly negligent act that was more than five-years past, even if the injury - or
cognizable legal harm - does not occur for many years. 
In Jones, we shifted away from the “absolute bar” description, allowing a claimant
to proceed with her action against a doctor who commenced his negligent treatment of Jones
many years before she filed her action, by treating each visit with the doctor as a potentially
separate negligence claim, thereby splitting the visits falling within five years prior to filing
suit from those falling earlier.  In doing so, we avoided Hill’s holding that the continuous
treatment doctrine was abrogated and allowed the claimant to proceed to trial on the
individual doctor visits that were within the five-year time limitation in § 5-109(a)(1).  In
contrast, our language sharpened in Newell, where we commented that § 5-109 creates a
“total bar to malpractice actions brought after five years from the date of the alleged
negligent treatment.”  Newell appeared to distance itself from the expansive definition of
“injury” in Hill.  
Despite our occasionally disparate characterizations of  § 5-109 in the past, we
conclude now that § 5-109(a)(1) is a statute of limitations because its trigger is an “injury”
which, under our holding in Hill, means when the negligent act is coupled with some harm,
rather than being dependent on some action independent of the injury.  The injury is the
cause of action and, thus, § 5-109(a)(1) does not immunize a health care provider simply
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through the passage of time following its negligent act or omission. 
CERTIFIED QUESTION ANSWERED AS
SET FORTH ABOVE. PURSUANT TO
SECTION 12-610 OF THE COURTS AND
JUDICIAL PROCEEDINGS ARTICLE, THE
COSTS SHALL BE EQUALLY DIVIDED
BETWEEN THE PARTIES.