Title: Navarro-Monzo v. Washington Adventist

State: maryland

Issuer: Maryland Supreme Court

Document:

In the Circuit Court for M ontgomery County
Case No. 238381
IN THE COURT OF APPEALS OF MARYLAND
No. 69
September Term, 2003
______________________________________
JULIO J. NAVARRO-MONZO, et ux.
v.
WASHINGTON ADVENTIST HOSPITAL
t/a ADVENTIST HEALTHCARE, INC., et al.
______________________________________
Bell, C.J.
        
Raker
Wilner
Cathell
Harrell
Battaglia
Eldridge, John C. (Retired, Specially
     Assigned),
   JJ.
______________________________________
Opinion by Wilner, J.
______________________________________
Filed:    March 11, 2004
The Circuit Court for Montgomery County dismissed this medical malpractice action
because, in that court’s view, appellants failed, when the case was pending before the Health
Claims Arbitration Office, to file an expert’s certificate within the time limit set forth in
Maryland Code, § 3-2A-04(b) of the Courts and Judicial Proceedings Article (CJP).  We
believe that the court erred and shall therefore reverse.
BACKGROUND
  Title 3, subtitle 2A of CJP creates an arbitration program for the resolution of
medical injury claims made against health care providers, in which damages in excess of the
concurrent jurisdiction of the District Court (currently $25,000) are sought.  CJP, §§ 3-2A-
02(a) and 3-2A-04 require that all such claims be filed initially with the Health Claims
Arbitration Office (HCAO).  Unless the jurisdiction of that office is waived pursuant to § 3-
2A-06A or §3-2A-06B, those claims are submitted to a form of non-binding arbitration,
subject to de novo trial in the Circuit Court.  See §§ 3-2A-05 and 3-2A-06.
In 1986, the General Assembly added a new requirement to the program.  Section 3-
2A-04(b)(1)(i) requires that the claim be dismissed if the claimant fails to file with the
Director of HCAO, within 90 days after the date of the complaint, a certificate of a qualified
expert attesting (1) to a departure from the standard of care by the defendant, and (2) that the
departure was the proximate cause of the alleged injury.  With amendments added in 1989,
however, § 3-2A-04(b)(1)(ii) states that, in lieu of dismissing the claim, the arbitration panel
chair “shall grant an extension of no more than 90 days” for filing the required certificate if
1 Section 3-2A-05(b)(2) requires that all discovery be completed within 270 days
after all defendants have been served.  Section 3-2A-05(g) sets certain time limits with
respect to the making of an arbitration award and delivery of the award to the HCAO
Director.
-2-
(1) the limitations period applicable to the claim has expired, and (2) the failure to file the
certificate was neither willful nor the result of gross negligence.  If the plaintiff files the
certificate and the defendant wishes to dispute liability, the defendant must then file a
certificate from a qualified expert attesting either to compliance with the standard of care or
that the alleged departure was not the proximate cause of the alleged injury.  If the defendant
fails to file such a certificate within 120 days after service of the plaintiff’s certificate, the
claim may be adjudicated in favor of the plaintiff on the issue of liability.  See §3-2A-
04(b)(2).
Two other statutory provisions – the ones principally at issue here – provide some
relief from these time requirements.  Section 3-2A-04(b)(5) states that “[a]n extension of the
time allowed for filing a certificate of a qualified expert under this subsection shall be
granted for good cause shown.”  (Emphasis added).  Section 3-2A-05(j), which is part of the
section dealing specifically with arbitration of the claim, provides that “[e]xcept for time
limitations pertaining to the filing of a claim or response, the [HCAO] Director or the
[arbitration] panel chairman, for good cause shown, may lengthen or shorten the time
limitations prescribed in subsections (b) and (g) of this section and § 3-2A-04 of this article.”
(Emphasis added).1
-3-
 On September 14, 2001, appellants Julio and Miryana Navarro-Monzo filed a
complaint with HCAO against Washington Adventist Hospital and Drs. Frank Gravino,
James Fonger, Norton Elson, and Herman Segal, alleging a number of sequential episodes
of medical malpractice.  The nature of the alleged malpractice is not important to the issues
before us.  Under CJP § 3-2A-04(b)(1)(i), appellants had until December 13, 2001, to file the
required certificate.  On December 13, they moved for an extension, explaining that they
were working with several physicians and were awaiting expert reports, “which has taken a
longer period of time than expected.”  On January 11, 2002, the HCAO Director granted an
extension of 69 days.  The order did not specify when the 69-day period commenced, and
thus was facially ambiguous.  If the period commenced on December 14, it would have
expired February 21, 2002; if it commenced on January 11, it would have expired March 21,
2002.  
Appellants apparently assumed that the extension ran to March 21, for, on that day,
they requested a second extension, again claiming that they were working with several
physicians and were awaiting expert reports.  This request was opposed by appellees.  Drs.
Gravino, Elson, and Segal took the position that the first extension expired on March 14,
apparently on the ground that the HCAO Director’s discretion was limited to an extension
of 90 days from December 14, and that, as the certificate had not been filed by then,
“pursuant to the strict and unyielding provisions provided in the Annotated Code,” no further
extension could be granted and the action had to be dismissed.  Neither the HCAO Director
2 The HCAO docket sheet shows that the four doctors filed expert certificates prior
to waiving arbitration.  There is no indication that any such certificate was filed by the
hospital.  As appellants do not raise that as an issue, we shall not make it one.
-4-
nor any panel chair made any immediate ruling on either the request for extension or the
motion to dismiss.  
On June 4, 2002, appellants, having received no response to their March 20 request,
moved for a third extension, asserting that, within 21 days, they would either file the required
certificate or report that no certificate would be forthcoming.  The next day, on June 5, the
HCAO Director granted a 30-day extension.  As with the first extension, the order did not
specify a commencement date for the 30-day period.  On July 5, 2002, appellants filed a
certificate from a Dr. David Davis asserting that the treatment by the appellee hospital and
doctors departed from the standards of care required of them and that the departure from
those standards was the proximate cause of the alleged injury.  Although they no doubt
disagree with Dr. Davis’s conclusions, appellees have never contested the substantive
validity of that certificate.
On September 17, 2002, Drs. Gravino, Elson, and Segal filed an election to waive
arbitration, and, by order of the HCAO Director, the case was transferred to the Circuit Court
for Montgomery County.  See CJP § 3-2A-06B(c) and (d), permitting a defendant to waive
arbitration after the plaintiff has filed his/her certificate, provided that the written waiver is
filed within 60 days after all defendants have filed their own expert’s certificate.2  In
accordance with CJP § 3-2A-06B(f), appellants filed a complaint in the Circuit Court.  That
3At oral argument, this Court posed the question of whether, once appellees
waived arbitration, any error in the granting of an extension by HCAO remained material. 
Because that issue was not raised or briefed by the parties, we shall address the issue that
was raised and reserve the materiality question for another time.
-5-
complaint was met by motions to dismiss filed by all appellees, based on the assertions that
(1) the second and third requested extensions were sought pursuant to CJP § 3-2A-
04(b)(1)(ii), which did not allow more than one 90-day extension, and (2) any extension
requested pursuant to CJP § 3-2A-04(b)(5) or 3-2A-05(j) must be filed before the expiration
of the time allowed for filing a certificate, and that the second and third requests were not
timely filed.  Appellees thus argued that the HCAO Director had no authority to grant the
untimely requests but was, instead, required to dismiss the claim.
The Circuit Court obviously found merit in that argument for, in a series of orders
entered in January and February, 2003, it dismissed the complaint against all defendants with
prejudice, citing as authority in each of its orders McCready Memorial Hosp. v. Hauser, 330
Md. 497, 624 A.2d 1249 (1993).  Appellants appealed, and we granted certiorari on our own
initiative prior to proceedings in the Court of Special Appeals to review those judgments.3
DISCUSSION
Appellees present the same argument to us that they raised in the Circuit Court,
namely, that § 3-2A-04(b)(1)(ii) permits but one 90-day extension and that, if any further
extension is to be sought under either § 3-2A-04(b)(5) or § 3-2A-05(j), the extension must
-6-
be sought before the expiration of the 90-day extension granted under § 3-2A-04(b)(1)(ii).
Relying on McCready, they aver that, once that extension period expires, the claim must be
dismissed.  Their reliance, and the Circuit Court’s reliance, on McCready is misplaced.
When the certificate requirement was added in 1986, there was no automatic extension
provision.  CJP § 3-2A-04(b)(1) provided that, unless the sole basis of the claim was the lack
of informed consent, the claim had to be dismissed, without prejudice, if the claimant failed
to file the certificate within 90 days from the date of the complaint.  Section 3-2A-04(b)(5)
permitted an extension for good cause shown, and § 3-2A-05(j) allowed the HCAO Director
or the arbitration panel chair to lengthen or shorten the time limitations for filing the
certificate for good cause shown.  
This construct came before the Court of Special Appeals in Robinson v. Pleet, 76 Md.
App. 173, 544 A.2d 1 (1988).  The plaintiff there filed her claim in November, 1986, but
failed to file the required certificate within the 90-day period.  On April 27, 1987, nearly five
months later, one of the defendants moved to dismiss.  On May 11, having received no
answer from the plaintiff, the panel chairman granted the motion and dismissed the claim.
Two days later, the plaintiff filed an answer, to which was attached the required certificate.
That was followed, a week later, by a motion for reconsideration of the dismissal.  That
motion was implicitly denied when the HCAO Director entered an award in favor of the
defendants.  The plaintiff then filed a complaint in the Circuit Court which, on motion, was
dismissed because of the default at the HCAO level.  
-7-
Treating the plaintiff’s failure to comply with the certificate requirement as equivalent
to a failure to arbitrate the claim, the Court of Special Appeals affirmed.  The appellate court
noted that, under § 3-2A-04(b), dismissal was mandatory if the certificate is not filed within
the 90-day period.  That was true, the court held, even though limitations had run on the
claim, thereby precluding a refiling of it, and the failure to file the certificate was not
deliberate.
As we pointed out in McCready, legislative reaction to Robinson was swift.  At its
next session following announcement of the Robinson decision, the General Assembly, after
considerable debate, amended § 3-2A-04(b) to add the mandatory extension language of
subsection (b)(1)(ii) – that, in lieu of dismissing the claim, the panel chair must grant an
extension of not more than 90 days for filing the required certificate if (1) limitations had by
then run on the claim, and (2) the failure to file the certificate was neither wilful nor the
result of gross negligence.
In McCready, the plaintiffs filed their claim on March 14, 1990, just a few days before
limitations ran.  When no certificate was filed within the 90-day period, the defendants
moved to dismiss the claim.  On July 3 – 111 days after the claim was filed – the plaintiffs
requested a 90-day extension under § 3-2A-04(b)(1)(ii), alleging that limitations had run and
that the failure to file the certificate was neither willful nor the result of gross negligence.
They did not seek a “good cause” extension under §3-2A-04(b)(5) or § 3-2A-05(j) and,
indeed, offered no explanation for the default.  HCAO took no immediate action on the
4 We did not take account of the prospect, in McCready, that an extension could be
granted under §3-2A-04(b)(1)(ii) for less than 90 days and simply assumed that the
plaintiff was entitled to a 90-day extension.  That erroneous assumption made no
difference in McCready.
-8-
request, but, following a hearing on October 17, the panel chairman dismissed the claim.  No
certificate had been filed, even at that point.  The plaintiffs filed a complaint in the Circuit
Court which, as in Robinson, was dismissed.  The Court of Special Appeals reversed that
judgment, but we affirmed it.
McCready gave us the opportunity to examine the relationship between the mandatory
extension provision in §3-2A-04(b)(1)(ii), on the one hand, and the good cause extension
provisions in §§ 3-2A-04(b)(5) and 3-2A-05(j), on the other.  We construed § 3-2A-
04(b)(1)(i) and (ii) as intended to operate in tandem and thus, where the two conditions
applied, to mandate an extension of 90 days, commencing not later than the end of the first
90-day period, even without a request.   Id. at 510, 624 A.2d at 1255-56 .4  Once the 180 days
had run, however, no further extension was permitted under § 3-2A-04(b)(1).
The good cause provisions in §§3-2A-04(b)(5) and 3-2A-05(j), we said, differ from
the provision in § 3-2A-04(b)(1)(ii) in that, on the one hand, they require the claimant to
establish good cause and do not permit an extension without such a showing, but, on the
other, “are silent as to the timing of a request, and they do not expressly limit the length of
any extension.”  Id. at 508, 624 A.2d at 1255.  “Presumably,” we added, “the length of the
extension, if granted, would be based on the nature of the ‘good cause’ shown.”  Id.
-9-
There are two significant differences between McCready and this case.  In McCready,
the plaintiffs never sought an extension based on good cause and offered no good cause for
the default, and, as noted, no certificate was ever filed with the HCAO.  Although we
concluded that the plaintiffs were entitled to an automatic 90-day extension under §3-2A-
04(b)(1)(ii), commencing on the 90th day following the date of the complaint, once that
period expired without a request for further good cause extension, §3-2A-04(b)(1)(i) became
applicable and the claim was required to be dismissed.  
Here, a timely request for extension was filed, on December 13.  Although that request
referenced “3-2A-04(ii)” – an incorrect reference, as no such section exists – it did offer a
good cause explanation for the extension, which would not have been necessary for an
automatic extension under §3-2A-04(b)(1)(ii).  The Director did not act on the request until
January 11, when he granted an extension of 69 days, without indicating a commencement
point.  The order was facially ambiguous.  As we have noted, if intended to run from
December 14, 2001, the 69-day period would have expired February 21, 2002.  If entered
under §3-2A-04(b)(1)(ii), it could not, in any event, extend beyond March 14 – a fact that,
in light of McCready, the HCAO Director must have known.  If the 69-day period was
intended to commence on the date of the order, which, in the absence of any provision
suggesting the contrary, is more likely the case, that period would end on March 21.  For
such a commencement date to be valid, however, the order would have to have been entered
pursuant to §3-2A-04(b)(5) or §3-2A-05(j), based on an implicit finding of good cause.  
-10-
We expressly recognized that prospect in McCready, noting that “there could
conceivably be instances where there might be ‘good cause’ to grant a request for an
extension that was made after the initial ninety-day period in lieu of dismissing the claim.”
McCready, 330 Md. at 506 n. 5, 624 A.2d at 1254 n.5.  Indeed, §§3-2A-04(b)(5) and 3-2A-
05(j) would have little or no meaning unless read to permit good cause extensions over and
above the mandatory extension called for in §3-2A-04(b)(1)(ii).  In construing statutes, the
paramount goal is to ascertain and carry out the intention of the Legislature.  In that regard,
when there are several statutory provisions dealing with the same subject, the courts must
strive, if at all possible, to harmonize and read them together, so that each may be given
effect.  See Balto. Gas & Elec. v. Public Serv. Comm’n, 305 Md. 145, 157, 501 A.2d 1307,
1313 (1986) (“[A] provision contained within an integrated statutory scheme must be
understood in that context and harmonized to the extent possible with other provisions of the
statutory scheme”); State v. Ghajari, 346 Md. 101, 115, 695 A.2d 143, 149 (1997) (quoting
State v. Harris, 327 Md. 32, 39, 607 A.2d 552, 555 (1992)) (“We presume that the legislature
intends its enactments ‘to operate together as a consistent and harmonious body of law.’”);
Carter v. Maryland Management, 377 Md. 596, 613, 835 A.2d 158, 168 (2003) (same). 
The several provisions at issue here may be read together without any difficulty.
Recognizing the harshness of the penalty it has exacted for failing to file a certificate within
the initial 90-day period, the General Assembly has provided three distinct, but
complementary, escape valves.  First, it has required that an extension of up to 90 days be
-11-
granted if the conditions stated in §3-2A-04(b)(1)(ii) are met.  Second, in §3-2A-04(b)(5) it
has provided that an extension without any fixed statutory limit shall be granted by the
Director or panel chairman for good cause shown.  And finally, in §3-2A-05(j), it has
allowed either of those persons to lengthen the time for filing the certificate, again without
any fixed limitation.
Especially as the right to grant indeterminate extensions was enacted as part of the bill
that imposed the requirement in the first instance, was stated twice in the law, and was not
amended in the 1989 enactment, there can be no doubt that it remains fully intact.
Notwithstanding a mandatory extension under §3-2A-04(b)(1)(ii), the Director and the panel
chairman retain the authority to grant a further extension, beyond 180 days from filing of the
claim, upon a showing of good cause.
It is evident that the HCAO Director regarded his January 11 order as extending to
March 21, for otherwise he would not (and under McCready could not) have granted a
further extension under §3-2A-04(b)(1)(ii).  Although the arbitration process itself is not in
the nature of an administrative remedy, HCAO is an administrative agency within the
Executive Branch of the State Government (see CJP § 3-2A-03), and therefore its Director,
in administering that office, acts as an administrative official.  In reviewing the
administrative decisions of the Director, we must afford at least the same deference that we
afford to other administrative agencies in making discretionary decisions, including, in the
absence of some clear indication in the record to the contrary, an assumption that the Director
-12-
is aware of the law controlling his/her conduct and acts in conformance with it.  We may
therefore properly assume that the Director was aware of our pronouncements in McCready
and regarded his January 11 extension of 69, rather than 90, days as one based on a finding
of good cause and not as a mandatory one under §3-2A-04(b)(1)(ii).
Upon this analysis, the request for further extension filed March 20, based on good
cause, was timely.  The HCAO Director did not act on that request until June 5, when he
granted a 30-day extension, presumably commencing from the date of the order and thus
implicitly including as well the period from March 21 to June 5.  As the certificate was filed
on the last day of that period, it too was timely.  The Circuit Court erred in dismissing the
complaint.
JUDGMENT OF CIRCUIT COURT FOR MONTGOMERY COUNTY
REVERSED; CASE REMANDED TO THAT COURT FOR FURTHER
PROCEEDINGS; COSTS TO BE PAID BY APPELLEES.