Opinion ID: 2185879
Heading Depth: 1
Heading Rank: 5

Heading: Burden of proof under such actions

Text: The general rule in negligence cases is thus stated in Prosser & Keeton on Torts, § 38, at 239 (5th ed. 1984): The burden of proof of the defendant's negligence is quite uniformly upon the plaintiff, since he is asking the court for relief, and must lose if his case does not outweigh that of the defendant's (footnote omitted). In 2 S.M. Speiser, Recovery for Wrongful Death § 12.1, at 288 (2d ed. 1975), it is said: The rule that the person who pleads the existence of a fact has the burden of proving such fact is applicable to wrongful death actions, and thus the statutory plaintiff has the same burden of proof that the decedent would have had if he had lived (footnote omitted). In F.B. Tiffany, Death by Wrongful Act § 189, at 426 (2d ed. 1913), the author also makes clear that this rule of law has application to cases involving negligence causing death: As in other actions, the burden of proof is upon the plaintiff to establish his case, including the fact that the death was caused by the wrongful act or neglect of the defendant, by a preponderance of evidence (footnote omitted). In 30 Am.Jur.2d Evidence § 1121, at 288-89, the rule is thus stated: The evidence must not leave the causal connection a matter of conjecture; it must be something more than consistent with plaintiff's theory as to how the accident occurred. Where the proof of causal connection is equally balanced, or the facts are as consistent with one theory as with another, plaintiff has not met the burden which the law casts upon him. If the evidence shows that an injury may have resulted from one of several causes, but only one of the causes can be attributed to the defendant's negligence, the plaintiff must fail (footnotes omitted). That Maryland courts long have recognized and applied this rule of law is beyond cavil. In Brady v. Consol Gas Co., 85 Md. 637, 641, 37 A. 263 (1897), it was said: All the cases agree that to constitute a good cause of action, there should be stated and proved a right on the part of the plaintiff, and a duty on the part of the defendant in respect to that right, and a breach of that duty by the defendant, whereby the alleged injury was produced. Between the negligence and the injury there must be the relation of cause and effect. Maenner v. Carroll, 46 Md. 212; W.U. Tel. Co. v. State, use of Nelson, 82 Md. 310; Holly v. Boston Gas Light Company, 8 Gray, 123; Trainor's case, 33 Md. 554, 33 A. 763. .... Having these well-established legal principles in view, we now proceed to a consideration of the facts in proof, bearing in mind that the onus is on the plaintiff to show affirmatively all the elements of the right to recover. It was necessary for the plaintiff in this case to prove (1) the death of Miss Brady; (2), the negligence of the defendant, and (3), that such negligence was the cause of Miss Brady's death (emphasis in the original). 85 Md. at 641-42, 37 A. at 264. The applicability of the above Maryland rule to cases of negligence causing death grounded upon medical malpractice is equally well settled. In State, Use of Janney v. Housekeeper, 70 Md. 162, 16 A. 382 (1889), we said: It was the duty of the professional men to exercise ordinary care and skill, and this being a duty imposed by law, it will be presumed that the operation was carefully and skillfully performed in the absence of proof to the contrary. As all persons are presumed to have duly performed any duty imposed on them, negligence cannot be presumed, but must be affirmatively proved. Best on Presump. 68; R.R. Co. v. Chappell, 21 Fla. 175. This principle is especially applicable in suits against physicians and surgeons for injuries sustained by reason of alleged unskillful and careless treatment. The burden of proof is on the plaintiff to show a want of proper knowledge and skill. Leighton v. Sargent, 31 N.H. 119; Baird v. Morford, 29 Ia. 531. The court below committed no error in determining that it was incumbent on the plaintiff to prove affirmatively that the operation was performed without the consent of the patient, and also that her death was caused by unskillful and careless treatment of the physicians. Nor did the court commit any error in granting the defendants' second prayer, which enunciates the proposition that if death was caused by tubercular meningitis or other disease not produced by the operation, the defendants are not liable. 70 Md. at 171, 16 A. at 384. The continuing applicability of the rule imposing the burden of proof upon the plaintiff in medical malpractice cases, is shown by Johns Hopkins Hospital v. Genda, 255 Md. 616, 621-22, 258 A.2d 595, 598-99 (1969). The Court in Housekeeper also approved the following prayer submitted by the defendant: `That the degree of care and skill to be exercised by physicians and surgeons in the performance of an operation is not the highest degree of care and skill known to the profession but that reasonable degree of care and skill which physicians and surgeons ordinarily exercise in the treatment of their patients; and the burden of proof is on the plaintiffs in this case to establish by preponderating evidence a want of such ordinary care and skill in the performance of the operation and attendance upon the said Matilda C. Janney' (emphasis supplied).... See also State, Use of Solomon v. Fishel, 228 Md. 189, 203, 179 A.2d 349 (1962); State, Use of Shockey v. Washington Sanitarium, 223 Md. 554, 558, 165 A.2d 764 (1960); Bettigole v. Diener, 210 Md. 537, 124 A.2d 265 (1956); State, Use of Kalives v. Baltimore etc. Hospital, 177 Md. 517, 526, 10 A.2d 612 (1940); Fink v. Steele, 166 Md. 354, 171 A. 49 (1934); Angulo v. Hallar, 137 Md. 227, 232, 233, 112 A. 179 (1920); Miller v. Leib, 109 Md. 414, 426, 72 A. 466 (1909); Dashiell v. Griffith, 84 Md. 363, 380-81, 35 A. 1094 (1896). See also Riley v. U.S., 248 F. Supp. 95, 97 (D.Md. 1965). In Kalives, supra, this Court stated: `Before the equitable plaintiffs can recover against any of the defendants, it must be shown by affirmative evidence that they were either unskilled or negligent in their respective capacities, and that such want of skill or care resulted in the death of Mr. Kalives. If either of the above elements is lacking in the proof, then no case for the consideration of the jury has been presented....' The rule of law governing the burden of proof in medical malpractice cases was reiterated in Pierce v. Johns-Manville Sales Corp., 296 Md. 656, 464 A.2d 1020 (1983). In that case, involving survival and wrongful death actions, the late Judge Davidson, speaking for this Court, said: In Maryland, recovery of damages based on future consequences of an injury may be had only if such consequences are reasonably probable or reasonably certain. Such damages cannot be recovered if future consequences are `mere possibilities.' Probability exists when there is more evidence in favor of a proposition than against it (a greater than 50% chance that a future consequence will occur). Mere possibility exists when the evidence is anything less. Davidson v. Miller, 276 Md. 54, 62, 344 A.2d 422, 427-28 (1975). 296 Md. at 666, 464 A.2d at 1026. We see no deviation from these rules of law in either the Hicks or the Thomas decisions. The basic issues for decision in both Hicks and Thomas, supra, were identical and were similarly stated by the distinguished judges who authored the opinions in the respective courts. In Hicks, supra, Judge Sobeloff, after his review of the record below, upon the issue of the negligence of the defendant said: On careful scrutiny, therefore, the government's expert is seen to have demonstrated that the examiner did not conform to the required standard of care. Coupled with the explicit testimony of the plaintiff's experts, the government's testimony leads us inevitably to the conclusion that the doctor was negligent as a matter of law (emphasis added). 368 F.2d at 631-32. On the question whether the evidence at trial established that [the doctor's] concededly erroneous diagnosis and treatment was the proximate cause of her death, Judge Sobeloff said: The government further contends that even if negligence is established, there was no proof that the erroneous diagnosis and treatment was the proximate cause of the death, asserting that even if surgery had been performed immediately, it is mere speculation to say that it would have been successful. The government's contention, however, is unsupported by the record. Both of plaintiff's experts testified categorically that if operated on promptly, Mrs. Greitens would have survived, and this is nowhere contradicted by the government expert (emphasis added). 368 F.2d at 632. He added, In sum, the dispensary physician's negligence in failing to make a thorough examination and in omitting standard diagnostic tests, led to an erroneous diagnosis. Because of this, he sent the patient home with instructions not to return for eight hours, rather than immediately admitting her to a hospital. Since the uncontradicted testimony was that with prompt surgery she would have survived, the conclusion follows that the dispensary doctor's negligence nullified whatever chance of recovery she might have had and was the proximate cause of the death (emphasis added). 368 F.2d at 633. Similarly, in Thomas, supra, Judge Barnes, after noting that we must resolve all conflicts in the evidence in favor of the plaintiffs and give them the benefit of all reasonable inferences to be derived from the evidence favorable to them, 265 Md. at 100, 288 A.2d at 389, examined the evidence on the record then before this Court and said: From what we have already stated, the jury could have reasonably concluded that under the circumstances of this case that if Dr. Thomas had performed his duty to attend Corso personally shortly after he was telephoned at 11:30 p.m., Dr. Thomas might well have been able to have saved his life and that this negligent conduct was one of the direct and proximate causes of Corso's death, concurrent with the negligence of the nurses. 265 Md. at 103, 288 A.2d at 390. In short, the Court in Hicks found that the record showed that negligence had been proven as a matter of law and that uncontradicted evidence showed that such negligence was the proximate cause of the death; this Court in Thomas found that the record showed evidence legally sufficient to establish negligence that was a proximate cause of the death. The appellees take comfort in our decision in State v. Fabritz, 276 Md. 416, 348 A.2d 275 (1975) wherein Chief Judge Murphy spoke for this Court on the principles of multiple contributing causes in death cases. The reliance would be apt if the appellees had succeeded in obtaining a favorable jury verdict. Under the instructions given by the trial court, such a contention not only was permissible, the argument actually was made by plaintiffs' counsel but was rejected by the jury. Appellees manifestly have misread our decision in Thomas, supra . They state in their brief at page 27: Obviously, if a judge grants a directed verdict, as occurred in Thomas v. Corso , the case does not even get to the jury  so any time the Plaintiff has not produced sufficient evidence (met the burden of proof) as a matter of law, there are no jury instructions. All that Thomas v. Corso said in the plainest (and consequently the most beautiful language possible) was that the judge applied the wrong burden of proof in granting the directed verdict. Such was not the status of Thomas v. Corso at the appeal to this Court. The trial judge in Thomas (with one exception not pertinent to that appeal) correctly, we held, denied the defendants' motion for a directed verdict. The jury rendered a verdict in favor of the plaintiffs. Our decision in Thomas v. Corso required us to determine whether the trial court erred in declining to grant motions for directed verdicts and for judgments n.o.v. in favor of [the appealing defendants]. Id. [265 Md.] at 86, 288 A.2d at 382. We concluded that it did not err. We decline to accept appellees' suggestion that such careful and analytical jurists as Judges Sobeloff and Barnes intended the quoted language in Hicks, supra, to alter, without discussion, the rule of law governing the burden of proof so anciently formed and so uniformly applied in wrongful death cases under the Maryland statute. Indeed, the circuit court for the Fourth Circuit itself has rejected such interpretation of those words. In Clark v. United States, 402 F.2d 950 (4th Cir.1968) that court said: Certainly Hicks laid down no new rule of law with respect to either negligence or proximate cause.... Id. at 953 n. 4. That same court in Waffen v. U.S. Dept. of Health & Human Services, 799 F.2d 911, 915 (4th Cir.1986) said: The general principles which ordinarily govern in negligence cases also apply to medical malpractice claims under Maryland law. A prima facie case of medical malpractice must consist of evidence which (1) establishes the applicable standard of care, (2) demonstrates that this standard has been violated, and (3) develops a causal relationship between the violation and the harm complained of. Fitzgerald v. Manning, 679 F.2d 341, 346 (4th Cir.1982). As in any other case founded upon negligent conduct, the burden of proof in a medical malpractice claim rests upon the plaintiff. Shilkret v. Annapolis Emergency Hospital Ass'n, 276 Md. 187, 349 A.2d 245, 247 (1975); Paige v. Manuzak, 57 Md. App. 621, 471 A.2d 758, 766-67 (1984). [7]