Case Title: Debbas v. Nelson

Citation: 389 Md. 364

Docket Number: 10/05

State: maryland

Court: Maryland Supreme Court

Date: 2005-11-09T00:00:00Z

Document:
IN THE COURT OF APPEALS OF
MARYLAND
No. 10
September Term 2005
__________________________________
ELIE G. DEBBAS, et al.
V.
THELMA NELSON, et al.
__________________________________
Bell, C.J.
Raker
Wilner
Cathell
Harrell
Battaglia
Greene,
JJ.
Opinion by Battaglia, J.
          Filed:  November 9, 2005
This case presents us with the task of determining whether a facially valid Certificate
of Qualified Expert, a prerequisite to instituting a medical malpractice action, can be
invalidated by subsequent developments, specifically the allegedly inconsistent deposition
testimony of the certifying medical expert.  We hold that the Health Care Malpractice Claims
Act does not permit such collateral attacks based on events arising after the Certificate has
been filed.  As such, Respondents’ Certificate of Qualified Expert was not substantially
defective, and the Circuit Court erroneously granted Petitioner Dr. Elie Debbas’s motion to
dismiss and Petitioner Fort Washington Hospital’s motion for summary judgment on that
basis.  
We have also been asked to explore whether a genuine dispute of material fact exists
regarding the vicarious liability of Petitioner Fort Washington Hospital.  We find that a
genuine dispute of material fact remains concerning whether the defendant physicians were
agents of the Hospital for the purposes of vicarious liability.  Therefore, we conclude that the
Circuit Court erroneously granted the Hospital’s motion for summary judgment.  
We shall affirm the decision of the Court of Special Appeals.
Facts
On May 10, 2000, Madeline V. Lyons went to the emergency room at Fort
Washington Hospital complaining of weakness and fatigue.  Dr. Hengameh N. Mesbahi
examined her, ordered various blood tests, and diagnosed Ms. Lyons with mild anemia.  He
wrote her a prescription for iron supplements and advised her to follow up with her primary
care physician, Dr. Michael Sidarous.  Two days later, Ms. Lyons visited Dr. Sidarous and
1
Section 3-2A-06B of the Courts and Judicial Proceedings Article provides in pertinent
part:
(continued...)
2
presented symptoms similar to those about which she had complained during her emergency
room examination.  Dr. Sidarous diagnosed Ms. Lyons with mild congestive heart failure,
prescribed medication, and informed her that she should return to the Hospital if her
symptoms worsened.  In the early hours of May 16, 2000, Ms. Lyons awoke with acute
burning abdominal pain and within several hours was admitted to the emergency room at the
Hospital, where she was treated by Dr. Patrick W. Daly, Director of the Hospital’s
Emergency Medical Department, Dr. Sidarous, and Dr. Elie G. Debbas, Chief of Surgery at
the Hospital and the then President of the Medical Staff. She died later that evening.  
On April 8, 2002, Ms. Lyons’s surviving five daughters (the “Respondents”) filed a
Statement of Claim against Dr. Debbas, Dr. Sidarous, and the Hospital with the Health
Claims Arbitration Office (“HCAO”), pursuant to the Maryland Health Care Malpractice
Claims Act (“the Act”), Md. Code (1974, 1998 Repl. Vol., 2000 Supp.), §§ 3-2A-01 to 3-2A-
09 of the Courts and Judicial Proceedings Article.  Accompanying the Statement of Claim
was a Certificate of Qualified Expert, executed by Dr. Ann M. Gordon, attesting to alleged
deviations from the proper standard of care committed by Dr. Sidarous, Dr. Debbas, and the
Hospital.  Respondents also simultaneously filed an Election to Waive Arbitration pursuant
to Maryland Code (2002 Repl. Vol.), § 3-2A-06B of the Courts and Judicial Proceedings
Article.1  On April 30, 2002, Respondents filed their complaint in the Circuit Court for Prince
1
(...continued)
(b)(1) Subject to the time limitation under subsection (d) of this
section, any claimant may waive arbitration at any time after
filing the certificate of qualified expert required by § 3-2A-04(b)
of this subtitle by filing with the Director a written election to
waive arbitration signed by the claimant or the claimant’s
attorney of record in the arbitration proceeding.
3
George’s County. 
The defendant physicians and the Hospital deposed Dr. Gordon, the certifying
physician, on November 8, 2002.  The following discourse occurred among Dr. Gordon and
counsel for Dr. Sidarous, Dr. Debbas, and the Hospital:
[COUNSEL FOR DR. SIDAROUS]: Based on your review of
the materials, have you formed opinions that you hold with
reasonable medical probability as to whether any health care
provider defendant deviated from standard of care in their care
and treatment of Madeline Lyons?
[DR. GORDON]: Yes, I do.
* * * 
[COUNSEL FOR DR. SIDAROUS]: I think I had asked you
who you hold such opinions with regard to.
[DR. GORDON]: Dr. Sidarous.
[COUNSEL FOR DR. SIDAROUS]: Have you formed any
opinions with regard to any other health care provider beyond
him?
[DR. GORDON]: No.
* * *
4
[COUNSEL FOR DR. DEBBAS]: Dr. Gordon, I’ll be very
short.  I represent Dr. Debbas, the surgeon in this case, and your
counsel was kind enough to say at the outset of your deposition
you don’t intend to render any opinions regarding my client, Dr.
Debbas, is that correct?
[DR. GORDON]: That’s correct.  I believe that there will be
other medical experts who will be addressing those opinions and
issues.
* * * 
[COUNSEL FOR FORT WASHINGTON HOSPITAL]: Are
you going to be rendering any opinions, Doctor, that Fort
Washington Medical Center or its employees deviated from the
standard of care?
[DR. GORDON]: I would probably defer that to the experts that
the plaintiff attorneys have concerning the emergency room visit
on 5/16 I believe.
[COUNSEL FOR THE HOSPITAL]: On 5/16?
[DR. GORDON]: Yes.
[COUNSEL FOR THE HOSPITAL]: Okay.  So you will not be
rendering any opinions then.  You’re going to defer to other
experts?
[DR. GORDON]: That’s correct.
The litigation proceeded on Respondents’ First Amended Complaint, which was filed
on November 22, 2002. On June 3, 2003, Dr. Debbas filed a motion to dismiss based on his
assertion that the above-quoted colloquy invalidated Respondents’ Certificate of Qualified
Expert.  On June 18, 2003, the Hospital filed a motion for summary judgment based upon the
same argument posited by Dr. Debbas as well as the assertion that the record could not
2
Although Dr. Patrick Daly, M.D., head of the Emergency Department of the Hospital,
and Dr. Mesbahi, Ms. Lyons’s initial treating physician, were not named in the Certificate
of Qualified Expert, Respondents, when amending their complaint, added Dr. Daly and Dr.
Mesbahi as additional defendants.  Dr. Daly and Dr. Mesbahi also filed motions to dismiss,
which were granted by the Circuit Court.  Respondents did not challenge those dismissals on
appeal.  Dr. Sidarous did not file a motion to dismiss or a motion for summary judgment.  
5
support a finding of negligence by the Hospital.2  Respondents filed an opposition to both
motions and appended an affidavit by Dr. Gordon in which she reaffirmed the statements
contained in her certification.  On August 29, 2003, the Circuit Court granted the motion to
dismiss and the motion for summary judgment on the basis that Respondents had failed to
establish a prima facie showing of apparent authority.  Respondents filed motions to
reconsider or amend the judgments, all of which were denied by the Circuit Court on October
2, 2003 and then filed their notice of appeal to the Court of Special Appeals on October 27,
2003.
In a reported opinion, the Court of Special Appeals determined that Respondents’
Certificate of Qualified Expert satisfied the Act’s requirements and reversed the Circuit
Court’s dismissal of the complaint against Dr. Debbas.  Nelson v. Debbas, 160 Md. App.
194, 208, 862 A.2d 1083, 1091 (2004).  Moreover, the appellate court held that the record
supported a finding that there existed a dispute of material fact relating to the apparent
authority of the physicians with respect to the Hospital and the potential vicarious liability
of the Hospital.  In part, the Court of Special Appeals relied upon the language in the medical
consent form that Ms. Lyons was required to sign prior to her admission to the emergency
6
room, which provided in pertinent part:
MEDICAL CONSENT: I hereby voluntarily consent to such
diagnostic procedures and hospital care and to such therapeutic
treatment by the doctors of the medical staff of Fort Washington
Hospital, which in their judgment becomes necessary while I am
an Emergency Department patient or an inpatient in said
hospital.
The appellate court also relied on the facts that Dr. Debbas was the President of the Medical
Staff and Chief of Surgery at the Hospital at the time of Ms. Lyons’s admission, and that Dr.
Daly was the Director of Emergency Medicine.  Based on these facts, the intermediate
appellate court determined that the evidence of record was sufficient to create a genuine
dispute of material fact regarding the issue of apparent authority and vicarious liability.  Id.
at 213, 862 A.2d at 1094.
On January 21 and 24, 2005, Dr. Debbas and the Hospital filed in this Court separate
petitions for writs of certiorari.  Dr. Debbas presented the following issue for our
consideration:
1.  Whether the Court of Special Appeals erred in reversing the
trial court’s decision to dismiss plaintiff’s medical negligence
suit on the grounds that an opinion given as part of a Certificate
of a Certifying Expert that is subsequently disavowed during
deposition testimony renders the Certificate invalid and
therefore must be dismissed.
The Hospital presented two issues for our review:
1.  Did the Court of Special Appeals err when it concluded that
the Affidavit of Ann M. Gordon, M.D., was not substantially
defective and complied with the Certificate of Qualified Expert
requirements of the Maryland Health Care Malpractice Claims
7
Act.
2.  Did the Court of Special Appeals err when it concluded that
there was sufficient evidence to create a dispute of material fact
on the question of whether there was an agency relationship
between the attending emergency room physicians, who
administered care to Ms. Lyons, at the Hospital.
On April 7, 2005, we granted the petitions and issued the writs.  Debbas v. Nelson,
386 Md. 180, 872 A.2d 46 (2005).  
We hold that the Certificate of Qualified Expert filed by the Respondents was not
defective due to events arising subsequent to its filing and that the Circuit Court erroneously
granted Dr. Debbas’s motion to dismiss and the Hospital’s motion for summary judgment on
that basis.  Moreover, we hold that sufficient facts exist in the record to create a genuine
dispute of material fact concerning whether the physicians and surgeons involved in this
matter were agents of the Hospital, thus rendering summary judgment improper.  Therefore,
we affirm the judgment of the Court of Special Appeals.
In reviewing the underlying grant of a motion to dismiss, we must assume the truth
of the well-pleaded factual allegations of the complaint, including the reasonable inferences
that may be drawn from those allegations.  Reichs Ford Road Joint Venture v. State Roads
Commission of the State Highway Administration, 388 Md. 500, 509, 880 A.2d 307, 312
(2005); Adamson v. Correctional Medical Services, 359 Md. 238, 246, 753 A.2d 501, 505
(2000); Allied Inv. Corp. v. Jasen, 354 Md. 547, 555, 731 A.2d 957, 961 (1999); Stone v.
Chicago Title Ins. Co. of Maryland, 330 Md. 329, 333, 624 A.2d 496, 498 (1993).  In the
8
end, “[d]ismissal is proper only if the complaint would fail to provide the plaintiff with a
judicial remedy.” Reichs Ford Road Joint Venture, 388 Md. at 509, 880 A.2d at 312, citing
Bobo v. State, 346 Md. 706, 709, 697 A.2d 1371, 1373 (1997).  See also Allied Inv. Corp.,
354 Md. at 555, 731 A.2d at 961.  In sum, because we must deem the facts to be true, our
task is confined to determining whether the trial court was legally correct in its decision to
dismiss.  See Allied Inv. Corp., 354 Md. at 555, 731 A.2d at 961; Bobo, 346 Md. at 709, 697
A.2d at 1373.  
With respect to the Hospital’s motion for summary judgment, we must determine,
initially, whether a dispute of material fact exists.  M d. Rule 2-501(f) (2002); Serio v.
Baltimore County, 384 Md. 373, 388, 863 A.2d 952, 961 (2004); O’Connor v. Baltimore
County, 382 Md. 102, 110, 854 A.2d 1191, 1196 (2004);  Todd v. MTA, 373 Md. 149, 154-
55, 816 A.2d 930, 933 (2003); Beyer v. Morgan State Univ., 369 Md. 335, 359, 800 A.2d
707, 721 (2002); Schmerling v. Injured Workers’ Ins. Fund, 368 Md. 434, 443, 795 A.2d
715, 720 (2002); see Fister v. Allstate Life Ins. Co., 366 Md. 201, 209, 783 A.2d 194, 199
(2001); Lippert v. Jung, 366 Md. 221, 227, 783 A.2d 206, 209 (2001).  “‘A material fact is
a fact the resolution of which will somehow affect the outcome of the case.’” Todd, 373 Md.
at 155, 816 A.2d at 933, quoting Matthews v. Howell, 359 Md. 152, 161, 753 A.2d 69, 73
(2000).  The facts properly before the court as well as any reasonable inferences that may be
drawn from them must be construed in the light most favorable to the non-moving party.
Serio, 384 Md. at 388, 863 A.2d at 961; O’Connor, 382 Md. at 111, 854 A.2d at 1196; Todd,
9
373 Md. at 155, 816 A.2d at 933; Okwa v. Harper, 360 Md. 161, 178, 757 A.2d 118, 127
(2000).  If the record reveals that a material fact is in dispute, summary judgment is not
appropriate.  Serio, 384 Md. at 388, 863 A.2d at 961; O’Connor, 382 Md. at 111, 854 A.2d
at 1196; Todd, 373 Md. at 155, 816 A.2d at 933; Okwa, 360 Md. at 178, 757 A.2d at 127.
If no material facts are disputed, however, then we must determine whether the circuit court
correctly granted summary judgment as a matter of law.  See Md. Rule 2-501(f); Serio, 384
Md. at 388, 863 A.2d at 961; O’Connor, 382 Md. at 111, 854 A.2d at 1197; Todd, 373 Md.
at 155, 816 A.2d at 933; Beyer, 369 Md. at 360, 800 A.2d at 721; Schmerling, 368 Md. at
443, 795 A.2d at 720.
Discussion
Dr. Debbas and the Hospital argue that when Dr. Gordon, in her deposition, did not
offer opinions with respect to alleged deviations from the standard of care committed by Dr.
Debbas and the staff of the Hospital, she rescinded the opinions that she had expressed in the
Certificate of Qualified Expert filed by Respondents, thereby rendering the Certificate
invalid.  According to Dr. Debbas and the Hospital, the Court of Special Appeals’s holding
that the Certificate was still effective significantly diminishes the Certificate’s role in
preventing specious claims from consuming limited judicial resources.  Moreover, Dr.
Debbas and the Hospital contend that the Court of Special Appeals erred in finding that a
deficient Certificate may be remedied with an affidavit from the certifying expert after the
statutory deadline for filing a Certificate has lapsed.  They note that the Maryland Health
10
Care Malpractice Claims Act does not permit such a remedy and thus, it is improper.
The Hospital also argues that the Court of Special Appeals erred in ruling that there
was a dispute of material fact with respect to Respondents’ allegations of apparent agency.
Specifically, the Hospital contends that the record lacks any evidence concerning
Respondents’ claim that the Hospital represented that the physicians were its agents and that
Ms. Lyons relied on those representations.  It asserts that Respondents failed to establish a
prima facie case of agency and therefore their theory of liability must fail.  
Conversely, Respondents contend that the holding of the Court of Special Appeals is
consistent with the legislative intent of the Maryland Health Care Malpractice Claims Act
because the Certificate of Qualified Expert was valid at the time it was filed and at all
subsequent times.  Moreover, Respondents assert that the affidavit submitted by Dr. Gordon
after the deposition was properly considered by the Court of Special Appeals because Dr.
Gordon never explicitly recanted her certifying opinion.  
Respondents also argue that the Court of Special Appeals was correct in determining
that there was sufficient evidence to present a genuine dispute of material fact on the issue
of the potential vicarious liability of the Hospital including the language of the consent form
signed by Ms. Lyons and Dr. Debbas’s title as President of the Medical Staff and Chief of
Surgery at the Hospital.  Furthermore, according to Respondents, the dismissal of Dr. Daly,
on grounds unrelated to the question of his negligence, does not preclude Respondents from
relying on the theory of apparent agency in holding the Hospital liable under a theory of
11
respondeat superior.  Even if the dismissal of Dr. Daly could preclude a claim against the
Hospital based upon his negligence, Respondents assert that the Hospital could still be found
to be vicariously liable due to Dr. Debbas’s deviation from the applicable standard of care
and the theory of Dr. Debbas’s apparent agency.  
The History of the Health Claims Arbitration Act
In the 1970's, medical malpractice insurers faced “a dramatic increase in the number
of malpractice suits being filed and an alarming rise in the dollar amounts of malpractice
verdicts.”  James Kevin MacAlister and Alfred L. Scanlan, Jr., Health Claims Arbitration in
Maryland: The Experiment has Failed, 14 U. BALT. L. REV. 481, 488 (1985).  The
proliferation of litigation was the result of several complex social factors, including the
“erosion of the traditional doctor-patient bond,” the increasing use of specialists for care as
opposed to general practitioners, and the increasing litigious nature of society.  Id. 
Medical malpractice insurers initially responded to the dramatic rise in litigation by
raising premium rates for physicians.  When rate increases were no longer sufficient to offset
the increased costs associated with defending malpractice suits, carriers began to cease
underwriting medical malpractice insurance in Maryland.  See St. Paul Fire & Marine Ins.
Co. v. Insurance Commissioner, 275 Md. 130, 339 A.2d 291 (1975).  
In 1975, St. Paul Fire & Marine Insurance Company (“St. Paul”), then Maryland’s
largest malpractice insurance carrier, informed the State Insurance Commissioner that it
intended to withdraw from the medical malpractice insurance market because it no longer
12
considered it profitable.  St. Paul Fire & Marine Ins. Co. v. Insurance Commissioner, 275
Md. 130, 134, 339 A.2d 291, 294 (1975).  The State Insurance Commissioner issued an order
proscribing St. Paul’s withdrawal and requiring it to continue to provide insurance coverage.
Id. at 135, 339 A.2d at 294.  The Baltimore City Court affirmed the Insurance
Commissioner’s order.  Id.  This Court reversed, stating that the Insurance Commissioner
could not require St. Paul to provide medical malpractice insurance, id. at 144, 339 A.2d at
299, and issued an immediate order.  Id. at 132, 339 A.2d at 292. 
The General Assembly responded by forming a committee to study the methods of
reforming the legal process of pursuing claims of medical malpractice.  The Medical
Malpractice Insurance Study Committee was appointed on July 23, 1975, and on January 6,
1976, issued its report.  Report of the Medical Malpractice Insurance Study Committee
(January, 1976).
The Committee proposed the adoption of a mandatory medical malpractice arbitration
system, which, it asserted, would improve traditional tort litigation by discouraging the
pursuit of non-meritorious claims because, through the arbitration process, weaknesses in
such a case would be revealed.  Id. at 3-8.  Moreover, the Committee opined that mandatory
arbitration would provide a means for “obtaining expert opinion on the question of
negligence,” which would lead to more reliable decisions as well as reasonable and
predictable awards.  Id. at 4 & 8.  The Committee appended proposed legislation to the
report, which was enacted by the General Assembly without substantive change as 1976 Md.
13
Laws, Chap. 235 and codified as Maryland Code (1974, 1977 Supp.), §§ 3-2A-01 et seq. of
the Courts and Judicial Proceedings Article.  
Mandatory arbitration became the rule; its process was described by Judge Robert L.
Karwacki, writing for this Court, as follows:
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 grounds 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 had been no award.’  In addition, attorneys’
fees are subjected to the approval respectively of the arbitration
panel and the court.
Carrion v. Linzey, 342 Md. 266, 276-77, 675 A.2d 527, 531-32 (1996), quoting Attorney
3
The collateral source rule permits an injured person to recover the full amount of his
or her provable damages, “regardless of the amount of compensation which the person has
received for his injuries from sources unrelated to the tortfeasor.”  Haischer v. CSX Transp.,
Inc., 381 Md. 119, 132, 848 A.2d 620, 628-29 (2004), quoting Motor Vehicle Admin. v.
Seidel, 326 Md. 237, 253, 604 A.2d 473, 481 (1992). 
14
General v. Johnson, 282 Md. 274, 279-80, 385 A.2d 57, 60-61 (1978).
The imposition of arbitration as a condition precedent to instituting suit in Circuit
Court, nevertheless, did little to resolve the crisis.  In 1983, the General Assembly adopted
a Senate Joint Resolution, 1983 Md. Laws, J. Res. 9, declaring that the cost of medical
liability insurance had increased ten-fold since 1975 and requested that the Governor appoint
a commission to examine the issue.  Witte v. Azarian, 369 Md. 518, 528, 801 A.2d 160, 166
(2002).  
The Commission on Health Care Providers’ Professional Liability Insurance, which
was appointed pursuant to the Joint Resolution, as stated in its 1984 Report to the Governor,
developed several recommendations, including (1) abolition of the arbitration scheme created
in 1976, (2) partial abolition of the collateral source rule,3 (3) a number of procedural
changes designed to streamline the arbitration procedure and allow parties to waive
arbitration completely if it were not abolished, and (4) a requirement that a malpractice
claimant file a certificate of a qualified expert within ninety days after the filing of a claim
attesting to a departure from the standard of care or of informed consent, as some other
jurisdictions had enacted.
Some of the Commission’s recommendations, including the requirement that a claim
15
be dismissed if the claimant failed to file a certificate from a qualified expert attesting to a
departure from the standards of care within ninety days from the date that the claim was filed
with the Health Care Arbitration Office, were presented to the 1984 session of the General
Assembly as Senate Bill 16.  The Bill, however, did not pass, which resulted in the formation
of another study group, the Joint Executive/Legislative Task Force on Medical Malpractice
Insurance.  Witte, 369 Md. at 529, 801 A.2d at 166.
The Task Force, in its December 1985 Report, noted that, since 1984, there had been
increases ranging from 30% to 250% in medical malpractice liability insurance premiums for
physicians in certain specialties.  Unlike the 1984 Commission, however, the Task Force did
not address whether the arbitration process should be abolished, but rather, presented a
number of recommendations similar to those made by the Commission to make the process
more efficient.  The Task Force reintroduced the requirement of a Certificate of Qualified
Expert, to be filed by both the claimant and the defendant, which was intended to eliminate
excessive damages and reduce the frequency of claims, and which consistently has been
considered as serving a gatekeeping function.  Report of the Joint Executive/Legislative Task
Force in Medical Malpractice Insurance, at 27 & 30 (Dec. 1985).  See Carrion, 342 Md. at
275, 675 A.2d at 531 (noting that the elements of the arbitration system, including the
Certificate, acted to “discourage litigation of non-meritorious claims”); McCready v.
Memorial Hospital, 330 Md. 497, 512, 624 A.2d 1249, 1256-57 (1993) (stating that the
Certificate is a central step in discouraging litigation of meritless claims through arbitration).
16
The Certificate requirement was presented to the General Assembly in Senate Bill
559.  In pertinent part, Senate Bill 559 provided that a claim filed after July 1, 1986, would
be dismissed if, within ninety days after the date that the claim was filed, the claimant did not
file a Certificate of Qualified Expert attesting to a departure from the standard of care with
the Health Claims Arbitration Office.  1986 Md. Laws, Chap. 640.  Senate Bill 559, enacted
as 1986 Maryland Law, chapter 640, was codified as Maryland Code (1974, 1984 Repl. Vol.,
1987 Cum. Supp.), Section 3-2A-04 of the Courts and Judicial Proceedings Article, which
provides in pertinent part:
(b) Filing and service of certificate of qualified expert. – Unless
the sole issue in the claim is lack of informed consent:
(1)(i) Except as provided in subparagraph (ii) of this paragraph,
a claim filed after July 1, 1986, shall be dismissed, without
prejudice, if the claimant fails to file a certificate of a qualified
expert with the Director attesting to departure from standards of
care, and that the departure from standards of care is the
proximate cause of the alleged injury, within 90 days from the
date of the complaint.  The claimant shall serve a copy of the
certificate on all other parties to the claim or their attorneys of
record in accordance with the Maryland Rules.  
* * *
(4) The attesting expert may not devote annually more than 20
percent of the expert’s professional activities to activities that
directly involve testimony in personal injury claims.
Md. Code (1974, 1984 Repl. Vol., 1987 Cum. Supp.), § 3-2A-04(b)(1) and (4) of the Courts
and Judicial Proceedings Article.
During the Legislature’s 1995 session, the General Assembly enacted another major
4
In their briefs, Petitioners also raise Respondents’ alleged failure to file a report with
the Health Claims Arbitration Office in accordance with Section 3-2A-04 (b)(3) as
appropriate grounds for the Circuit Court’s dismissal and grant of summary judgment, but
did not raise the issue in their petitions for writs of certiorari.  Accordingly, the issue is not
before us.  See Md. Rule 8-131 (b).
17
change in the Health Claims Arbitration Act by permitting waiver of the entire arbitration
process by either party.  1995 Md. Laws, Chap. 582, codified as M d. Code (1974, 2002 Repl.
Vol.), § 3-2A-06B of the Courts and Judicial Proceedings Article. 
With this history in mind, we turn to the case sub judice.
Certificate of Qualified Expert
Petitioner Debbas, in his motion to dismiss, and the Hospital, in its motion for
summary judgment, challenge the adequacy of Respondents’ Certificate of Qualified Expert.4
Specifically, Petitioners assert that Respondents’ expert recanted her opinions regarding the
negligence of Dr. Debbas and the staff of the Hospital during her deposition testimony in
preparation for trial.  To determine whether Respondents’ Certificate of Qualified Expert is
subject to invalidation by subsequent events, we must first examine the applicable provisions
of the Health Care Malpractice Claims Act.
Section 3-2A-04 of the Courts and Judicial Proceedings Article provides in pertinent
part:
(b)(1)(i)  Except as provided in subparagraph (ii) of this
paragraph, a claim or action filed after July 1, 1986, shall be
dismissed, without prejudice, if the claimant fails to file a
certificate of qualified expert with the Director [of the Health
Care Arbitration Office] attesting to departure from standards of
18
care, and that the departure from standards of care is the
proximate cause of the alleged injury, within 90 days from the
date of the complaint.
* * *
(3) Discovery is available as to the basis of the certificate.
Md. Code (1974, 1998 Repl. Vol., 2000 Supp.), §§ 3-2A-04 (b) (1)(i) and (3) of the Courts
and Judicial Proceedings Article.
When attempting to ascertain the meaning of a statute, “we first look to the normal,
plain meaning of the language. . . .  If that language is clear and unambiguous, we need not
look beyond the provision's terms. . . .” Bienkowski v. Brooks, 386 Md. 516, 536, 873 A.2d
1122, 1134 (2005); Davis v. Slater, 383 Md. 599, 604, 861 A.2d 78, 81 (2004). “Moreover,
when the meaning of a word or phrase in a constitutional or statutory provision is perfectly
clear, this Court has consistently refused to give that word or phrase a different meaning on
such theories that a different meaning would make the provision more workable, or more
consistent with a litigant's view of good public policy, or more in tune with modern times,
or that the framers of the provision did not actually mean what they wrote.” Bienkowski, 386
Md. at 537, 873 A.2d at 1134.
The statutory language of Section 3-2A-04(b) explicates the requirements for a valid
Certificate of Qualified Expert; it must be filed within ninety days after the claim is
submitted to the Health Care Arbitration Office and “attest[] to [the] departure from
standards of care, and that the departure from standards of care is the proximate cause of the
alleged injury.”  Md. Code, (1974, 1998 Repl. Vol., 2000 Supp.), § 3-2A-04 (b)(1)(i) of the
19
Courts and Judicial Proceedings Article.  The statute also provides that the certifying expert
may not devote more than 20% of his or her professional activities to “activities that directly
involve testimony in personal injury claims.”  Id. at §3-2A-04 (b)(4). 
In the present case, Respondents’ Certificate of Qualified Expert states:
I, Ann M. Gordon, M.D., hereby certify as follows:
I am a practicing physician, board certified in Internal Medicine.
I have reviewed the medical records of Madeline V. Lyons.
From my review of the records it is my opinion that Michael G.
Sidarous, M.D., Elie G. Debbas, M.D., and the staff at Fort
Washington Hospital deviated from applicable standards of
medical care in connection with their care and treatment of
Madeline V. Lyons.
It is my further opinion that the deviations from the standard of
care were the proximate cause of the death of Madeline V.
Lyons.
I do not annually devote more than 20% of my professional
work to activities that involve testimony in personal injury
claims.
I have read the above and certify that it is true and correct to the
best of my knowledge, information and belief.
The parties concede that the Certificate was timely filed and do not dispute that Dr. Gordon
is qualified to render an opinion regarding Petitioners’ conduct under the terms of Section
3-2A-04.  Moreover, in the Certificate, Dr. Gordon attested specifically to the named
defendants’ deviations from the applicable standard of medical care and opined that such
deviations were the proximate cause for Ms. Lyons’s demise.  No one suggests that
Respondents did not file a valid Certificate of Qualified Expert based upon the above.  
Petitioners argue that Section 3-2A-04(b)(3) provides for discovery with respect to
20
the “basis of the certificate,” and therefore, a collateral attack based on events subsequent to
the Certificate’s filing is appropriate.  Essentially, Petitioners are arguing that the General
Assembly intended “discovery” to invalidate an otherwise facially valid certificate.  Of
course, if the General Assembly had intended discovery or any subsequent event to be used
as a mechanism to invalidate an otherwise valid Certificate, it could have so stated and
converted the recognized gatekeeping function of the Certificate to a penultimate bar to
litigation.  See Carrion, 342 Md. at  275, 675 A.2d at 531 (noting that the elements of the
arbitration system acted to “discourage litigation of non-meritorious claims”); McCready,
330 Md. at 512, 624 A.2d at 1257 (1993) (stating that the Certificate is an indispensable step
in discouraging litigation of meritless claims through arbitration).  
The plain language of the statute does not comport with Petitioners’ arguments.  To
go beyond the plain language would mean that when a simultaneous waiver of arbitration is
filed, the original Certificate would bind the plaintiff to the use and judgment of the original
expert.  Any subsequent information, including that gleaned through interrogatories and
requests for production of documents or through testimony in other depositions or in court
proceedings, would likewise be binding upon the claimant.  According to Petitioners, if the
subsequent information was in any way inconsistent with the Certificate filed many months,
if not years, before, it would render the Certificate invalid, barring the plaintiff from seeking
any redress.  Such a result does not conform with the plain language of the statute.
The time period delineated in Section 3-2A-04(b) also indicates that the Certificate
21
of Qualified Expert Requirement was not intended to be subject to this kind of collateral
attack.  The Section requires that the Certificate be filed within 90 days of the date of the
complaint, with extensions available upon a showing of good cause.  Md. Code (1974, 1998
Repl. Vol., 2000 Supp.), § 3-2A-04 (b)(1)(i) of the Courts and Judicial Proceedings Article.
Although this provides sufficient time to obtain medical records and possibly obtain
deposition testimony from the parties, it is certainly not adequate for the claimant to fully
prepare his or her case on the merits.  The strictly limited time period provided for securing
a valid Certificate of Qualified Expert demonstrates the General Assembly’s intention that
the findings and opinions contained therein would be preliminary.  To interpret the statute
otherwise might effectively preclude many malpractice suits from ever proceeding on the
merits.  
Our conclusion is consistent with the jurisprudence of this Court in Witte v. Azarian,
369 Md. 518, 801 A.2d 160 (2002), and the Court of Special Appeals in D’Angelo v. St.
Agnes Healthcare, Inc., 157 Md. App. 631, 853 A.2d 813 (2004).  In Witte, the petitioner,
Dr. Jeffrey Witte, challenged the validity of the plaintiff’s Certificate of Qualified Expert
based on the certifying expert’s deposition testimony that approximately 60% of his patients
were referred from either attorneys or workers’ compensation insurance carriers.  Id. at 523,
801 A.2d at 163.  Dr. Witte’s challenge, although ultimately unsuccessful, was permissible
because it was based upon a statutory prerequisite for a valid certificate and only examined
the circumstances in existence at the time of the Certificate’s filing.
5
Because it is clear from the language of Section 3-2A-04 that a collateral attack based
on subsequent events is not permitted, we need not reach the Court of Special Appeals’s
application of the “sham affidavit” doctrine as stated in Pittman v. Atlantic Realty Co., 359
Md. 513, 529, 754 A.2d 1030, 1038 (2000), because we do not consider Dr. Gordon’s
subsequent affidavit.
22
The factual scenario in D’Angelo, is similarly distinguishable from the case at bar.
In D’Angelo, the petitioner filed two Certificates of Qualified Experts that failed to
individually name the defendant physicians in their opinions concerning the deviations from
the applicable standards of care and that such deviations were the proximate causes of the
injuries at issue.  Id. at 635, 853 A.2d at 816.  As in Witte, the defendant physicians and
hospital challenged the validity of the Certificate based on its failure to comply with the
terms of the statute when it was filed.  Id. at 635-36, 853 A.2d at 816.
Were we to reach the opposite conclusion, an otherwise valid Certificate of Qualified
Expert would be rendered invalid if the certifying expert at some later date became a
professional witness or even died.  Such a harsh result would be inconsistent with the intent
of the General Assembly.5 
Apparent Authority
In its motion for summary judgment, the Hospital also asserts that Respondents lacked
sufficient evidence to create a question of material fact regarding the agency relationship
between the defendant physicians and the Hospital.  The Hospital contends that the
physicians were independent contractors and that no agency relationship exists.  The Circuit
Court, in orally granting the Hospital’s motion for summary judgment, stated that there was
23
“insufficient evidence to support a continuation of the case on the basis of apparent
authority.”  We disagree. 
In the context of medical malpractice litigation, we have endorsed the apparent
authority theory of agency as stated in the Restatement (Second) of Agency Section 267,
which provides in pertinent part:
One who represents that another is his servant or other agent and
thereby causes a third person justifiably to rely upon the care or
skill of such apparent agent is subject to liability to the third
person for harm caused by the lack of care or skill of the one
appearing to be a servant or other agent as if he were such.
See Mehlman v. Powell, 281 Md. 269, 273, 378 A.2d 1121, 1123 (1977), quoting B.P. Oil
Corp. v. Mabe, 279 Md. 632, 643, 370 A.2d 554, 560 (1977).  
In Mehlman v. Powell, a case analogous to the case sub judice, the plaintiff visited a
hospital emergency room for medical treatment.  The plaintiff had no knowledge that the
emergency department of the hospital was not operated by the hospital, but rather by an
independent contractor.  An emergency room physician, Dr. Cosca, ordered an
electrocardiogram, a physical examination, x-rays, and other various tests, and subsequently
made an initial diagnosis of pneumonitis.  At trial, it was undisputed that the
electrocardiogram revealed severe abnormalities, that Dr. Cosca’s reading of it was
erroneous, and that this misreading contributed to the plaintiff’s demise.  Mehlman, 281 Md.
at 271, 378 A.2d at 1122.
Judge Eldridge, writing for this Court, explicated why the Court rejected the hospital’s
24
argument that it could not be vicariously liable for the actions of an independent contracting
physician’s negligence:
[A] [h]ospital . . . is engaged in the business of providing health
care services.  One enters the hospital for no other reason.
When [the plaintiff] made the decision to go to [the hospital], he
obviously desired medical services and equally obviously was
relying on [the hospital] to provide them.  Furthermore, the
[h]ospital and the emergency room are located in the same
general structure. . . .  It is not to be expected, and nothing put
[the plaintiff] on notice, that the various procedures and
department of a complex, modern hospital . . . are in fact
franchised out to various independent contractors.
Id. at 274, 378 A.2d at 1124.  Ultimately, we held that the hospital was liable for the
physician’s negligence because it had represented that the staff in the emergency room were
its employees, and that the representation caused the decedent to rely on the staff’s skill.  Id.
at 275, 378 A.2d at 1124.  
In the case sub judice, as a prerequisite to admission into the Hospital’s emergency
room, Ms. Lyons was required to sign a consent form containing the following language:
MEDICAL CONSENT: I hereby voluntarily consent to such
diagnostic procedures and hospital care and to such therapeutic
treatment by doctors of the staff of Fort Washington Hospital,
which, in their judgment becomes necessary while I am an
Emergency Department patient or an inpatient in said hospital.
The language clearly states that the doctors practicing in the Hospital are Hospital staff.
Moreover, the record indicates that at the time of the events at issue in the case at bar, Dr.
Debbas was the President of the Medical Staff and Chief of Surgery at the Hospital.  This
fact, when considered in conjunction with the language of the medical consent form and our
25
determination in Mehlman, creates a genuine dispute of material fact with respect to the
relationship between the defendant physicians and the Hospital as well as Ms. Lyons’s
reliance thereon.  Therefore, we agree with the Court of Special Appeals’s determination that
the Circuit Court improperly granted summary judgment in favor of Fort Washington
Hospital.  
Conclusion
Because we determine that Respondents’ Certificate of Qualified Expert is valid and
that there was sufficient evidence of record to create a genuine issue of material fact on the
issue of apparent authority and vicarious liability, we shall affirm the Court of Special
Appeals’s decision to reverse both the Circuit Court’s dismissal of Respondents’ claim
against Dr. Debbas and vacate its grant of summary judgment in favor of Fort Washington
Hospital.  
JUDGMENT OF THE COURT OF SPECIAL
APPEALS AFFIRMED WITH COSTS.