Title: Goicochea v. Langworthy

State: maryland

Issuer: Maryland Supreme Court

Document:

No. 106, September Term, 1995
Juvenal R. Goicochea v. John A. Langworthy
[Whether A Civil Claim That A Licensed Maryland Physician Committed
An Assault And Battery On A Patient During A Routine Medical
Examination, Under The Circumstances Presented By This Case, Is
Covered By The Maryland Health Care Malpractice Claims Act, Maryland
Code (1974, 1995 Repl. Vol.), §§ 3-2A-01 Through 3-2A-09 Of The
Courts And Judicial Proceedings Article]  
IN THE COURT OF APPEALS OF MARYLAND
No. 106
September Term, 1995
________________________________________
JUVENAL R. GOICOCHEA
v.
JOHN A. LANGWORTHY
_______________________________________
   *Murphy, C.J.,
Eldridge
Rodowsky
Chasanow
Karwacki
Bell
Raker, JJ.
________________________________________
Opinion by Eldridge, J.
________________________________________
        Filed:  June 6, 1997
*Murphy, C.J., now retired, participated
in the hearing and conference of this
case while an active member of this
Court; after being recalled pursuant to
the Constitution, Article IV, Section
3A, he also participated in the decision
and the adoption of this opinion.
The issue before us is whether a civil claim that a licensed
Maryland physician committed an assault and battery on a patient
during a routine medical examination, under the circumstances
presented by this case, is covered by the Maryland Health Care
Malpractice Claims Act, Maryland Code (1974, 1995 Repl. Vol.),
§§ 3-2A-01 through 3-2A-09 of the Courts and Judicial Proceedings
Article.  We shall answer this question in the affirmative and
shall reverse the judgment of the Court of Special Appeals.  
I.
The petitioner, Dr. Juvenal R. Goicochea, performed a hernia
examination on the respondent, John A. Langworthy, to determine the
source and cause of pain in Langworthy's groin area.  Langworthy
consented to this examination, which occurred at Goicochea's office
in Bethesda, Maryland.  In the weeks and months following the
examination, Langworthy complained of persistent pain and dis-
comfort in his groin area.  He filed a medical malpractice claim
with the Health Claims Arbitration Office (HCAO) pursuant to the
Health Care Malpractice Claims Act, alleging that Goicochea's
performance of the hernia examination resulted in chronic pain,
abnormal swelling, and the laceration of soft tissue in his groin
area.  He did not, however, file a qualified expert's certificate
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       Section 3-2A-04(b) of the Courts and Judicial Proceedings
1
Article states:
"(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 [of the HCAO] 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 . . . .
   (ii) In lieu of dismissing the claim,
the panel chairman shall grant an extension of
no more than 90 days for filing the certifi-
cate required by this paragraph, if:
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."   
of merit with the HCAO as required by § 3-2A-04(b)(1) of the Act.1
The HCAO, therefore, dismissed the claim.  
Prior to the HCAO's dismissal of his malpractice claim,
however, Langworthy filed the instant assault and battery action
against Goicochea in the Circuit Court for Montgomery County,
requesting compensatory and punitive damages.  In his complaint,
Langworthy asserted that, during the hernia examination, Goicochea
"intentionally assaulted and battered [his] left inguinal area with
the full force of his left forefinger for approximately five
minutes."  Although he did not allege a precise motive for
Goicochea's actions, Langworthy stated that the "assault and
battery" was "malicious" and "willful," and resulted in "perman-
- 3 -
ently painful injury."  
Goicochea filed a motion to dismiss, arguing that, in light
of the Health Care Malpractice Claims Act, the circuit court should
not exercise jurisdiction over the action.  Following a hearing,
the circuit court, relying upon this Court's opinion in Jewell v.
Malamet, 322 Md. 262, 587 A.2d 474 (1991), dismissed Langworthy's
complaint.  The circuit court pointed out that Langworthy claimed
that he had been assaulted and battered during the rendering of
medical treatment by a health care provider, and that the Health
Care Malpractice Claims Act was therefore applicable unless the
complaint's factual allegations removed the claim from the Act's
coverage.  The court held that Langworthy's factual allegations did
not remove the claim from the statute's coverage.  In addition,
the circuit court reasoned that, by not filing the required
certificate of merit, Langworthy had failed to pursue the special
arbitration remedy prescribed by the Act.  The court concluded that
staying the tort action until the conclusion of arbitration
proceedings under the Act would be inappropriate because the HCAO
had already dismissed Langworthy's malpractice claim for failure to
follow the proper procedures.   
Langworthy appealed to the Court of Special Appeals which
vacated the judgment of the circuit court. Langworthy v. Goicochea,
106 Md. App. 265, 664 A.2d 422 (1995).  The Court of Special
Appeals' holding, and its view of Jewell v. Malamet, supra, were
set forth as follows (106 Md. App. at 274-275, 664 A.2d at 427):
- 4 -
"Based on the foregoing, we conclude that a
wilful and deliberate act other than one
usually involved in medical treatment or
examination on the part of the physician, such
as an assault and battery, does not qualify as
a `medical injury' as defined by the Act.  A
wilful and deliberate act to assault and
batter is not a breach of a professional duty
because a professional duty is one required in
the proper exercise of the profession.
"In Jewell, the Court instructed the
parties to return to the HCAO so that the HCAO
could determine whether the claim fell within
the ambit of the Act, before proceeding with
the tort claim in the circuit court.  The
Court's holding in Jewell creates a curious
situation.  Under Jewell, when a claimant is
injured while receiving medical care, the
claimant must file with the HCAO, which then
determines whether the claim arises out of a
medical injury; however, in order to file a
claim with the HCAO, the claimant must file a
certificate of merit of qualified expert.  If
the claim is unquestionably one for assault
and battery, then the claimant will be unable
to obtain a certificate of merit of qualified
expert.  Under the Act, if the claimant fails
to file a certificate of merit of qualified
expert, then the HCAO can not hear the case.
Therefore, a claimant with a legitimate as-
sault and battery claim will never be able to
have his case heard."
Thereafter, Goicochea filed with this Court a petition for
a writ of certiorari which we granted.  Goicochea v. Langworthy,
340 Md. 649, 667 A.2d 897 (1995).
II.
Goicochea argues that Langworthy's cause of action, despite
its "assault and battery" label, alleges a "medical injury" and is
subject to the Health Care Malpractice Claims Act and its require-
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ments.  He maintains that the complaint implicates the Act because
Langworthy's injury was allegedly inflicted during the rendering of
medical services, and that the complaint's factual allegations are
insufficient to remove Langworthy's claim from the Act's coverage.
Thus, according to Goicochea, the HCAO, and not the circuit court,
should make the threshold determination whether Langworthy's
assault and battery action is subject to the Act.  In Goicochea's
view, the Court of Special Appeals' holding "usurp[s] the power of
the HCAO to initially evaluate potential malpractice claims when a
claimant fails to sufficiently allege conduct outside the Act in
circuit court."  Moreover, Goicochea maintains that the inter-
mediate appellate court's decision allows a claimant to circumvent
the Act entirely by filing a civil action in the circuit court
alleging assault and battery if the claimant is unable or unwilling
to procure the certificate of merit required by the Act.  He
asserts that this result makes the Act largely inapplicable, and
the certification requirement meaningless, because both can be
easily avoided.
Langworthy, on the other hand, argues that Goicochea
intentionally and deliberately injured him under the pretext of
providing medical treatment.  He asserts that an intentional
assault and battery committed by a health care provider against a
patient can never be a "medical injury" and is therefore outside
the scope of the Act.  While conceding that he consented to the
performance of the hernia examination, Langworthy maintains that
- 6 -
     
 Section 3-2A-02 states, in pertinent part, as follows:
2
"(a) Claims and actions to which subtitle
applicable. -- (1) All claims, suits, and
actions, including cross claims, third-party
claims, and actions under Subtitle 9 of this
title, by a person against a health care
provider for medical injury allegedly suffered
by the person in which damages of more than
the limit of concurrent jurisdiction of the
District Court are sought are subject to and
shall be governed by the provisions of this
subtitle.
(2) An action or suit of that type may not
be brought or pursued in any court of this
State except in accordance with this subti-
tle."
In his complaint in the circuit court, Langworthy sought
compensatory damages in the amount of $300,000 and punitive damages
in the amount of $300,000 against Goicochea, amounts clearly
exceeding the $20,000 maximum limit on the concurrent subject
matter jurisdiction of the District Court.  See §§ 4-401(1) and 4-
402(d) of the Courts and Judicial Proceedings Article.
Goicochea's intent to injure him stripped the examination of any
medical validity.  Finally, Langworthy argues that the intermediate
appellate court correctly directed the circuit court, instead of
the HCAO, initially to determine whether his assault and battery
claim is subject to the Act. 
III.
Absent a waiver by the parties, the Health Care Malpractice
Claims Act requires the submission of malpractice claims against
health care providers to an arbitration proceeding as a condition
precedent before maintaining a tort action in the circuit court.2
See, e.g., Goodwich v. Nolan, 343 Md. 130, 151, 680 A.2d 1040, 1050
- 7 -
(1996); Jewell v. Malamet, supra, 322 Md. at 265, 587 A.2d at 475-
476; Tranen v. Aziz, 304 Md. 605, 612, 500 A.2d 636, 639 (1985);
Bailey v. Woel, 302 Md. 38, 41, 485 A.2d 265, 266 (1984); Oxtoby v.
McGowan, 294 Md. 83, 91, 447 A.2d 860, 865 (1982); Attorney General
v. Johnson, 282 Md. 274, 283-284, 385 A.2d 57, 63, appeal dis-
missed, 439 U.S. 805, 99 S.Ct. 60, 58 L.Ed.2d 97 (1978).  See also
the discussion of the Act by Judge Chasanow for the Court in Newell
v. Richards, 323 Md. 717, 727-734, 594 A.2d 1152, 1157-1161 (1991).
The Act is limited to claims against health care providers for
medical injuries.  The statute states that "`[m]edical injury'
means injury arising or resulting from the rendering or failure to
render health care."  See § 3-2A-01(f).  Thus, the critical
question is whether Langworthy's injury from an alleged assault and
battery constitutes a "medical injury" within the meaning of the
Act. 
In Cannon v. McKen, 296 Md. 27, 34, 459 A.2d 196, 200
(1983), this Court explained the definition of "medical injury" as
follows:
"[T]he legislature did not intend that claims
for damages against a health care provider,
arising from non-professional circumstances
where there was no violation of the provider's
professional duty to exercise care, to be
covered by the Act.  It is patent that the
legislature intended only those claims which
the courts have traditionally viewed as pro-
fessional malpractice to be covered by the
Act."
The Court went on to state that, in order to bypass the Act's
- 8 -
arbitration requirement, a claimant "must allege sufficient facts
to make clear the theory upon which the alleged liability is
based."  Cannon v. McKen, supra, 296 Md. at 38, 459 A.2d at 202. 
 In Nichols v. Wilson, 296 Md. 154, 156 n.2, 460 A.2d 57, 58 n.2
(1983), a minor plaintiff, by her parents, filed a multi-count
complaint in the circuit court alleging that an emergency room
physician, "before" removing sutures from the plaintiff's cheek,
"without provocation, . . . intentionally, violently, maliciously,
wantonly and recklessly" struck the plaintiff "with great force" in
the face.  In assessing whether these factual allegations were
sufficient to remove the claim from the Act's coverage, this Court
held (Nichols v. Wilson, supra, 296 Md. at 161, 460 A.2d at 61): 
"[The plaintiff's] declaration clearly sounds
in traditional assault and battery terms and
alleges an intentional, malicious, wanton and
reckless act.  In no way can it be said that
the legislature intended such a claim to be
within the Act . . . ."  (Emphasis in
original).
We also stated, however, that intentional torts were not auto-
matically excluded from the Act's coverage, and that "there may
well be many [intentional torts] that would be so covered."  296
Md. at 161 n.5, 460 A.2d at 61 n.5.  
Jewell v. Malamet, supra, 322 Md. 262, 587 A.2d 474,
clarified the holding in Nichols v. Wilson, concerning the
circumstances under which intentional torts, allegedly committed by
health providers during the rendering of medical care, are covered
- 9 -
by the Act.  Jewell involved a plaintiff's allegation that a
physician had "intentionally, wrongfully, willfully, maliciously
and violently" assaulted and battered her by fondling her vaginal
and breast areas during the course of two musculoskeletal examina-
tions.   This Court initially pointed out that "`[t]he determina-
tion of jurisdiction in cases involving an intentional tort of a
professional nature lies not in . . . the label given to the tort
. . ., but on the factual context in which the tort was allegedly
committed.'"  Jewell v. Malamet, supra, 322 Md. at 271-272, 587
A.2d at 479.  See also Brown v. Rabbit, 300 Md. 171, 175, 476 A.2d
1167, 1169 (1984) ("the critical question is whether the claim is
based on the rendering or failure to render health care and not on
the label placed on the claim").  The Court in Jewell went on to
hold that, "[i]n the face of the allegations, we cannot say, as a
matter of law, that the claims as set out were not for medical
injury allegedly suffered by Jewell."  322 Md. at 274, 587 A.2d at
480.  The Court noted, however, that it was possible for a
plaintiff to allege facts showing that the health care provider's
tortious conduct "had no conceivable validity as part of the
examination being conducted," and thus "the resolution of the case
would be for the trier of fact in the circuit court as an action
for assault and battery, not as a medical malpractice action for
the arbitration panel."  322 Md. at 275, 587 A.2d at 481.
Nevertheless, we concluded in Jewell that, "[i]nasmuch as we cannot
say that the allegations suffice to take [the claim] out of the
- 10 -
Act, the proper initial forum is that provided under the Act."  322
Md. at 276, 587 A.2d at 481.  
Consequently, under Jewell, the determination of the proper
initial forum for cases involving allegations of intentional torts
committed by health care providers depends upon the factual context
in which the tort was allegedly committed.  Where a plaintiff
alleges that he or she was injured by a health care provider during
the rendering of medical treatment or services, the Act is
implicated, regardless of whether the claim sounds in negligence or
intentional tort.  When confronted with such a claim, the trial
court must determine if the plaintiff's factual allegations remove
the claim from the Act's coverage.  If the complaint sets forth
facts showing that the claimed injury was not inflicted during the
rendering of medical services, or that the injury resulted from
conduct completely lacking in medical validity in relation to the
medical care rendered, the Act is inapplicable, and the action may
proceed without first resorting to arbitration.
  
Under our holding in Jewell, however, if the trial court is
unable to conclude that the allegations remove the claim from the
Act's coverage, the court should not exercise jurisdiction over the
claim until a malpractice claim is filed with the HCAO.  The HCAO
initially will determine if the claim alleges a "medical injury"
and is therefore subject to the Act.       
The circuit court in the present case correctly held that
Langworthy's allegations were insufficient to remove his claim from
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the coverage of the Health Care Malpractice Claims Act.  Langworthy
specifically alleged that Goicochea caused his groin injury by
improperly conducting a hernia examination.  Langworthy fails to
set forth any factual basis upon which the circuit court could
properly conclude that Goicochea's actions had no conceivable
medical validity or were totally unrelated to the performance of a
routine hernia examination.  Obviously, Goicochea had to apply some
measure of force to Langworthy's left groin area in order to
ascertain the precise location of Langworthy's groin pain.  The
asserted cause of Langworthy's injury was that Goicochea allegedly
applied too much force.  This appears to fall in the category of a
traditional malpractice action.  A plaintiff may not remove a
medical malpractice action from the ambit of the statute simply by
adding the adjectives "malicious" or "willful."  This case cannot
be distinguished, on any principled basis, from Jewell v. Malamet,
supra.  
Normally, when a claim subject to the Act's requirements is
filed in the circuit court, the court should stay the civil action
pending the conclusion of arbitration proceedings.  See Jewell v.
Malamet, supra, 322 Md. at 276, 587 A.2d at 481.  Where, however,
a claim is dismissed by the HCAO because the plaintiff failed to
follow the mandatory requirements of the Act, this Court has held
that the plaintiff may not maintain a subsequent civil malpractice
action against the health care provider in the circuit court.  See,
e.g., Wyndam v. Haines, 305 Md. 269, 273-274, 503 A.2d 719, 722
- 12 -
(1986); Tranen v. Aziz, supra, 304 Md. at 612-614, 500 A.2d at 639-
640; Bailey v. Woel, supra, 302 Md. at 45, 485 A.2d at 268; Oxtoby
v. McGowan, supra, 294 Md. at 91, 447 A.2d at 865.
Langworthy's malpractice claim against Goicochea was
dismissed by the HCAO because he did not file the certificate of a
qualified medical expert attesting to the merit of his claim, as
required by § 3-2A-04(b) of the Act.  Therefore, staying the
present civil action would serve no purpose.  The circuit court
correctly held that dismissal of the action was appropriate.
JUDGMENT OF THE COURT OF SPECIAL
APPEALS 
REVERSED, 
AND 
CASE
REMANDED TO THAT COURT WITH
DIRECTIONS TO AFFIRM THE JUDGMENT
OF THE CIRCUIT COURT FOR MONT-
GOMERY COUNTY.  RESPONDENT TO PAY
COSTS IN THIS COURT AND IN THE
COURT OF SPECIAL APPEALS.