Court Opinion

ID: 9691926
Source: CourtListenerOpinion
Date Created: 2023-08-25 15:26:28.997611+00
Date Added: 2024-06-11T18:19:28.430295
License: Public Domain

*216Dissenting Opinion by
BELL, Chief Judge.
At the commencement of this action, Mrs. Earlene Burnside had resided in Baltimore City, Maryland for more than twenty-five years. In September, 2001, she sought ophthalmic care and treatment for background, diabetic retinopathy, which was present in both eyes,1 from Dr. Randall V. Wong, at his Baltimore County office. On November 15, 2001, Dr. Wong treated Mrs. Burnside by performing a bilateral laser coagulation procedure. He noted subsequently, during an April 8, 2002 office visit, that Mrs. Burnside’s visual acuity was stable. Thereafter, on September 16, 2002, Mrs. Burnside was diagnosed with proliferative diabetic retinopathy, a more advanced form of diabetic retinopathy. Dr. Wong treated this new condition by performing laser coagulation procedures on both eyes.2 While receiving care and treatment from Dr. Wong, Mrs. Burnside continued to reside in Baltimore City.
Then totally blind in her right eye and legally blind in her left eye, Mrs. Burnside and her husband filed in the Circuit Court for Baltimore City a complaint against Dr. Wong, alleging negligence, breach of informed consent and loss of consortium. Dr. Wong moved to dismiss, arguing, pursuant to Maryland Code (1973, 2002 Repl. Vol) § § 6-201(a)3 and 6-202(8)*2174 of the Courts and Judicial Proceedings Article, that venue was improper. Addressing only section 6-201 (a), as the parties had done, the hearing court ruled that venue in Baltimore City was improper and transferred the case to Baltimore County. In her Motion to Reconsider, Alter, Amend or Revise the trial court’s ruling, Mrs. Burnside argued that venue was proper under section 6-202(8). In support of that position, Mrs. Burnside attached the affidavit of an expert, Dr. Newsome, who opined that Mrs. Burnside more likely than not suffered the subject eye injury in Baltimore City. Specifically, he said:
“5. It is my opinion to a reasonable degree of medical probability that the first (but not only) eye injury that Mrs. Burnside suffered while under Dr. Wong’s care was when her background retinopathy was allowed to progress to proliferative retinopathy, a more severe condition, despite indications for treatment that more likely than not would have prevented that progression. It is my opinion that this transition from background to proliferative retinopathy occurred during April 8, 2002 and September 16, 2002.
“6. This transition from background to proliferative retinopathy was a gradual process. It is my understanding that Mrs. Burnside lived in Baltimore City between April 8, 2002 and September 16, 2002, as well as before and since that timeframe. It is my further understanding that though some of Mrs. Burnside’s work activities took her into counties other than Baltimore City at times, she spent far more time in Baltimore City than in any other County during this period.
“7. Based on the foregoing assumptions, and my understanding of the process of the transition from background to proliferative retinopathy, it is my opinion to a reasonable degree of medical probability that Mrs. Burnside’s first eye *218injury while under Dr. Wong’s care occurred more likely than not where she spent the vast majority of her time—in Baltimore City.”
The motion was denied, prompting Mrs. Burnside’s appeal to the Court of Special Appeals. That court affirmed the trial court’s ruling, explaining:
“In our view, the teachings of Jones [v. Speed, 320 Md. 249, 577 A.2d 64 (1990)], Rivera [v. Edmonds, 347 Md. 208, 699 A.2d 1194 (1997)], and Green [v. North Arundel Hospital Association, Inc., 366 Md. 597, 785 A.2d 361 (2001)] compel the conclusion that Mrs. Burnside suffered an injury, and thus her malpractice claim arose, when Dr. Wong allegedly failed to diagnose her condition on April 8, 2002, in Baltimore County.
“Just as the plaintiff in Jones, Mrs. Burnside sustained an ‘injury’ when Dr. Wong allegedly failed to diagnose the worsening of her diabetic retinopathy in his office in Baltimore County on April 8, 2002. As explained in Rivera, ‘any delay1 caused by the misdiagnosis is harm where the medical condition was progressing and worsening after the misdiagnosis. Finally, just as the plaintiff in Green, Mrs. Burnside’s injury occurred on April 8, 2002, even though all of the resulting damage had not occurred at that time. Therefore, we hold that, under section 6-202(8), venue is proper only in Baltimore County.”
II
The majority holds that:
“[U]nder Section 6-202(8) of the Courts and Judicial Proceedings Article, venue is proper in a medical malpractice and lack of informed consent action where the alleged misdiagnosis, negligent treatment, or negligent failure to inform, giving rise to the harm, occurs.”5
412 Md. 180,186, 986 A.2d 427, 430 (2009). It reasons:
*219“The progressively worsening retinopathy and the potentiality of the ultimate harm, the proliferative type, had to coexist at the time of the alleged misdiagnosis, so that the allegation of failure to properly diagnose and treat could not arise absent the presence of the disease and its potentiality. Accepting, for our purposes, that the transition from background to proliferative diabetic retinopathy represents a gradual process, as Dr. Newsome suggests, the disease must have been germinating, as was the disease in Owens-Illinois, Inc. v. Armstrong, where we also interpreted the language of arising, 326 Md. [107,] 121, 604 A.2d [47,] 54 [(1992)], for Dr. Wong’s negligent acts to constitute misdiagnosis and mistreatment. Therefore, Mrs. Burnside’s cause of action arose in Baltimore County, where Dr. Wong’s alleged misdiagnosis, mistreatment, and failure to obtain informed consent occurred.” (footnotes omitted).
Id. at 206-07, 986 A.2d. at 442-43. I disagree with the majority’s holding and the analysis underlying it.
Under the Courts and Judicial Proceedings Article, a plaintiff must bring a tort claim based on negligence either: “where the defendant, resides, carries on a regular business, is employed, or habitually engages in a vocation,” § 6-201(a), or “[w]here the cause of action arose.” § 6-202(8). When section 6-202(8) is the basis for venue, the trial Court, as a threshold matter, has to resolve the factual question, Rivera v. Edmonds, 347 Md. 208, 220, 699 A.2d 1194, 1201 (1997); Hill v. Fitzgerald, 304 Md. 689, 697, 501 A.2d 27, 31 (1985), of where the “injury” first occurred. “ ‘Medical injuries’... refers to legally cognizable wrongs or damage arising or resulting from the rendering or failure to render health care,” Oxtoby v. *220McGowan, 294 Md. 83, 94, 447 A.2d 860, 866 (1982), and is “concerned with the invasion of legally protected interests coupled with harm.” Id. This Court previously has faced the issue of deciding exactly when, a critical issue for resolving where, for the purpose of determining venue, an “injury” has occurred. To make the determination of when a person sustains an “injury,” this Court follows the test set out in Rivera v. Edmonds, supra. There, quoting the intermediate appellate court’s opinion in Edmonds v. Cytology Services of Maryland, Inc., 111 Md.App. 233, 270, 681 A.2d 546, 564 (1996), we observed:
“[T]he patient could suffer an ‘injury’ as a result of a negligent misdiagnosis, when (1) he or she experiences pain or other manifestation of an injury; (2) the disease advances beyond the point where it was at the time of the misdiagnosis and to a point where (a) it can no longer effectively be treated, (b) it cannot be treated as well or as completely as it could have been at the time of the misdiagnosis, or (c) the treatment would entail expense or detrimental side effects that would not likely have occurred had treatment commenced at the earlier time; or (3) the patient dies.”
347 Md. at 215, 699 A.2d at 1198. Significantly, the Court noted that the Court of Special Appeals vacated the summary judgment entered in favor of the defendants, emphasizing that court’s rationale for doing so:
“[Plaintiffs] did not proffer any expert opinion that Ms. Edmonds’s cancer had not spread at any time prior to April 9, 1988 (i.e., the date five years prior to the filing of the claim) on April 11,1985 (i.e., the date five years prior to Ms. Edmonds’s death). But [Defendants] did not advance any evidence, beyond conclusory assertions, to show that Ms. Edmonds’s cancer had advanced during those time periods. Nor do [Defendants] contend that Edmonds suffered any symptoms from the cancer prior to August 1988. Therefore, we conclude that the circuit court erred.... ”
347 Md. at 215-16, 699 A.2d at 1198, quoting Edmonds v. Cytology Services, 111 Md.App. at 272, 681 A.2d at 565. The *221Court then proceeded to apply a similar rationale to its resolution of that case:
“The decision in this case turns on the nature of microscopic cervical cancer, as revealed by the record. Because the standard of care calls for surgery or radiation treatment when the condition is diagnosed, the Defendants contend that any delay, and certainly a protracted delay, caused by a misdiagnosis is a harm within the meaning of Hill. Ordinarily we would have no disagreement with that assessment in a case, such as Jones v. Speed, 320 Md. 249, 577 A.2d 64, where the uncontradicted evidence on summary judgment is that the undiagnosed cancer was progressing and worsening during the period following the misdiagnosis, even if the cancer was asymptomatic. Id. at 256, 577 A.2d at 67. “Here, however, the evidence most favorable to the party opposing summary judgment is that the cancer that allegedly should have been detected in Mrs. Edmonds in July 1983 could remain dormant for as long as five years. The inference most favorable to the plaintiff is that there are no additional adverse consequences if the microscopic tumor remains unchanged. The Defendants have not attempted to demonstrate that Dr. Rocereto’s statement is junk science. Nor did the Defendants develop from him the probability of the undiagnosed condition’s remaining dormant for five years.”
347 Md. at 222-223, 699 A.2d at 1202. See Green v. North Arundel Hospital Association, Inc., 366 Md. 597, 610, 785 A.2d 361, 369 (2001).
In Green, we granted certiorari to resolve in which court, the Circuit Court for Baltimore City or the Circuit Court for Anne Arundel County, venue properly belonged. Both courts had concluded that venue lay in Anne Arundel County.6
*222Green, the injured party, was born with “a medical condition in which abnormal accumulation of fluid in the cerebral ventricles caused increased brain pressure.” One morning, he began to experience a headache, and later that day, began to vomit and feel nauseous. When his symptoms continued on the following day, his father took him to the North- Arundel Hospital Association’s (NAHA) emergency room. After examining Green, reviewing the results of an emergency CT scan and consulting with a neurologist, the examining doctor gave him a prescription painkiller and discharged him once the pain was gone. The following day, Green, still complaining of headaches, was taken to a doctor’s office in Anne Arundel County and then immediately to the University of Maryland Hospital (UMH) in Baltimore City. While at UMH, he suffered a cardiac arrest, which left him severely brain damaged.
Green filed an action in the Circuit Court for Baltimore City against NAHA and the examining physician at NAHA, although both did business only in Anne Arundel County and the physician resided there. He premised his choice of venue on Section 6-202(8), relying on the fact that it was in Baltimore City that he suffered his cardiac arrest, which he maintained was the injury giving rise to his cause of action. The trial court did not agree. It ruled that Section 6-201(a), rather than Section 6-202(8), was the applicable provision and that, pursuant to that section, venue lay in Anne Arundel County, where the defendants resided and/ or did business. Although the Court of Special Appeals held that Section 6-202(8) applied, it affirmed the judgment for the defendants, concluding that Green’s injury occurred in Anne Arundel County. In affirming the intermediate appellate court, this Court explained:
“In answers to interrogatories, the plaintiff averred that, after leaving NAHA and before reporting to UMH the next afternoon, Darwin [Green] suffered a continued ‘neurological deterioration’ from the ever-increasing intracranial pres*223sure. Although Darwin seeks not to brush it aside, the fact is that, as a result of the alleged negligence of the Anne Arundel County defendants in failing to diagnose the shunt malfunction and have plaintiff sent immediately to a facility capable of dealing with that problem, Darwin continued to suffer from headaches, drowsiness, and neurological deterioration. That constitutes a ‘hurtful or damaging effect’ (■Oxtoby); it is the kind of harm we recognized in Jones as construing an injury; and it clearly falls within the scope of ‘pain or other manifestation of an injury’ under Rivera. Clearly, Darwin, through his parents, could have sued the NAHA defendants on [the day they saw Darwin].”
The Court further stated:
“It is evident that the Court of Special Appeals reached the only conclusion possible—that because appellant’s own evidence showed that Darwin first experienced injury in the form of ‘neurological deterioration’ and pain and suffering in Anne Arundel County, the cause of action arose in that County. Venue thus lay in Anne Arundel County, and no error was committed by the Circuit Court for Baltimore City in transferring the case.” (citations omitted)
Green, 366 Md. at 612, 785 A.2d at 369-70.
Ill
In the instant case, as in Green, we must determine, for the purpose of establishing venue under Section 6-202(8), where Mrs. Burnside’s injury occurred. An injury may be either symptomatic or asymptomatic. Webster’s Third New International Dictionary 2318 (2002), defines a symptomatic condition as “being a symptom of a disease; characteristic, indicative.” An asymptomatic condition, on the other hand, is one “presenting no subjective evidence of disease.” Id. at 136.
The injury in Green was, the majority in effect held, symptomatic. The plaintiffs painful headaches were symptomatic of an injury and evidence that the plaintiff had suffered an injury at NAHA as a result of the negligent misdiagnosis he alleged. There is no such symptom of injury in Mrs. Burn*224side’s case. That she suffered with diabetic retinopathy is not in dispute. That her diabetic retinopathy progressed to proliferative retinopathy also is not in dispute. Moreover, the record does not reflect that this progression was accompanied by any visible or tangible manifestation that it was occurring. On the contrary, the progression to proliferative retinopathy was without any apparent symptoms; it was asymptomatic. The critical question, therefore, is when, at what point did, Mrs. Burnside’s diabetic retinopathy disease advance beyond the point where it was at the time of misdiagnosis to a point where it (a) could no longer effectively be treated or (b) it could no longer be treated as well or as completely as it could have been at the time of misdiagnosis. Edmonds v. Cytology Services, 111 Md.App. at 270, 681 A.2d at 564.
Green teaches that a plaintiff who experiences pain before, during and after a misdiagnosis, suffers an “injury” for venue purposes, under Section 6-202(8); the injury and misdiagnosis coincide.7 366 Md. at 612, 785 A.2d at 370. The majority extends the Green holding to a plaintiff whose injury is asymptomatic, who neither experiences pain nor otherwise manifests symptoms of an injury, reasoning that the injury, in this case, the “progressively worsening retinopathy and the potentiality of the ultimate harm, the proliferative type,” 412 Md. at 206, 986 A.2d at 442, must have coexisted with the misdiagnosis. Thus, after the decision in the instant case, in misdiagnosis cases, venue always will lie at the site of the misdiagnosis, whether or not there are manifestations of the injury, whether it is symptomatic or asymptomatic. This interpretation of injury renders the test announced in Edmonds and adopted by this Court, as well as Section 6-202(8), meaningless. I addressed this very concern in my dissent in Green:
*225“[The Edmonds] test provides alternative methods, depending upon the existing circumstances, of determining when an ‘injury’ has occurred. To be sure, one alternative applies when the plaintiff experiences pain or other manifestation of an injury. But that alternative must be juxtaposed against the alternative that applies when the injury has progressed beyond the point at which it was at diagnosis, such that it cannot then be treated or treatment would be more difficult or expensive. The latter alternative must apply to the situation in which the misdiagnosis is of an asymptomatic injury. Logically, a different test, at least as difficult to prove, must apply when the condition that is misdiagnosed is symptomatic. That test, I submit, must require proof that the pain being experienced indicates a deterioration of the condition beyond where it was when the diagnosis was made.”
Green, 366 Md. at 639, 785 A.2d at 386.
In Oxtoby, we stated that an “injury” is the “effect on the recipient in the way of hurt or damage.” 294 Md. at 94, 447 A.2d at 866. The only hurt or damage being experienced by Mrs. Burnside when her condition was misdiagnosed was the background retinopathy with which she already was suffering; that, not the deterioration of the existing eye disease to a point affecting treatment or Mrs. Burnside’s treatment prospects or the resulting progression itself of the condition to proliferative retinopathy, was the only condition that coexisted with Dr. Wong’s misdiagnosis. Indeed, there was expert evidence that the progression of Mrs. Burnside’s background retinopathy to proliferative retinopathy occurred some time after the misdiagnosis and before the discovery of her injury. To be an “injury,” within the contemplation of section 6-202(8), there must have been a progression of Mrs. Burnside’s background retinopathy to a more serious condition; the status of Mrs. Burnside’s retinopathy must have deteriorated significantly from what it was when the faulty diagnosis was made. Where there is no pain or other objective and overt manifestation of injury, that means deterioration “beyond the point at which it was at diagnosis, such that it cannot then be *226treated or treatment would be more difficult or expensive,” Green, 366 Md. at 639, 785 A.2d at 386 (Bell, C.J., dissenting), than it would have been had the diagnosis been correct. Thus, Mrs. Burnside’s injury could not have arisen until, as a result of Dr. Wong’s misdiagnosis, she was caused greater harm than that she was experiencing at the time of diagnosis. That,—according to the only expert testimony—, more likely than not occurred in Baltimore City, where Mrs. Burnside spent the majority of her time.
Moreover, it is well settled that an ‘injury’ “refers to a legally cognizable wrong or damage resulting from the rendering or failure to render health care.” Oxtoby, 294 Md. at 94, 447 A.2d at 866; See also Hill, 304 Md. at 695-96, 501 A.2d at 30. It follows that a misdiagnosis and “injury” cannot coexist. You cannot simultaneously have ah asymptomatic injury resulting from a failure to diagnose.8 Unless it is sympto*227matic, Green, 366 Md. at 612, 785 A.2d at 370, an “injury” resulting from a misdiagnosis cannot “coexist” with the misdiagnosis, the result of the misdiagnosis simply cannot precede or coincide with the diagnosis. It must occur after the misdiagnosis has been made.
The majority states, further, that “[i]n Oxtoby, we conceived ‘injury’ in the context of a progressive illness, ovarian cancer, in terms of ‘the effect on the recipient in the way of hurt or damage,’ and noted that ‘a medical injury occurs ... even though all of the resulting damage to the patient’ has not yet occurred.” 412 Md. at 205-06, 986 A.2d at 442. I do not disagree with this statement. I simply disagree with the majority’s application of the Oxtoby decision to the instant case. I do not contend that Mrs. Burnside’s injury occurred at the time she discovered that her background retinopathy had progressed to proliferative retinopathy; injury-deterioration of the status quo of the disease at diagnosis-undoubtedly had occurred prior to that discovery. Moreover, I agree with Rivera, which the majority cites to support its holding, in which we rested “on the nature of microscopic cervical cancer, as revealed by the record.” 347 Md. at 222, 699 A.2d at 1202. The decision in this case, likewise, must rest on the nature and *228the progression of Mrs. Burnside’s proliferative retinopathy, as revealed by the record. And the record in this case contains expert opinion, offered by Mrs. Burnside, that she was injured when her existing eye injury, the background retinopathy, was allowed to progress to proliferative retinopathy, that was a gradual process that occurred between April 8, 2002 and September 16, 2002 and that, during this period, Mrs. Burnside “resided in Baltimore City and spent nearly all of her leisure time there.” She estimated that “she spent more than seventy-five percent ... of the total hours in any given week in Baltimore City.” There is no other “medical opinion, medical record, or medical testimony” to suggest otherwise.
The evidence in this case is the exact opposite of that found in Jones v. Speed, “where ... the uncontradicted evidence on summary judgment was that the undiagnosed cancer was progressing and worsening during the period following the misdiagnosis, even if the cancer was asymptomatic.” Rivera, 347 Md. at 223, 699 A.2d at 1202. Although I believe that the record in this case suggests that the progression of Mrs. Burnside’s disease occurred some time after the misdiagnosis and before the discovery of the injury, at the very least whether it did is a jury question.
My view is consistent with how other jurisdictions have defined “injury” resulting from a misdiagnosis. Estate of Genrich v. OHIC Ins. Co., 318 Wis.2d 553, 769 N.W.2d 481, 487 (2009) (“... an actionable injury arises when the [negligent act or omission] causes a greater harm than [that which] existed at the time of the [negligent act or omission]”); Paul v. Skemp, 242 Wis.2d 507, 625 N.W.2d 860, 870 (2001) (“[T]he misdiagnosis [in a medical malpractice action] is the negligent act or omission. The misdiagnosis is not the injury. The misdiagnosis may or may not result in an injury; and, that injury may occur concurrently, or there may be a delay between the misdiagnosis and the injury.”).
I continue of the view I expressed, in dissent, in Green, the majority’s interpretation renders the “venue statute a nullity *229because [under its analysis] an action for misdiagnosis of’ any condition, whether symptomatic or asymptomatic, “would necessarily, and always, have to be brought where the misdiagnosis occurred.” 366 Md. at 640, 785 A.2d at 386. Therefore, I dissent.

. Diabetic retinopathy was defined by the court below:
"The entry in Stedman’s Medical Dictionary (28th ed. 2006) entitled 'diabetic retinopathy' states the general definition as ‘retinal changes, occurring in diabetes mellitus, marked by microaneurysms, exudates, and hemorrhages, sometimes by neovascularization.' ” (citations omitted).

. On August 21, 2003, Dr. Wong performed a surgical and laser and coagulation procedure on Mrs. Burnside's left eye. On October 9, 2003, Dr. Wong performed a laser coagulation procedure on Mrs. Burnside’s right eye. And, on December 18, 2003, he performed another laser coagulation procedure on her right eye.

. Maryland Code (1973, 2006 Repl. Vol) § 6-201(a) of the Courts and Judicial Proceedings Article provides:
"Civil actions.—Subject to the provisions of §§ 6-202 and 6-203 of this subtitle and unless otherwise provided by law, a civil action shall be brought in a county where the defendant resides, carries on a regular business, is employed, or habitually engages in a vocation.”

. Section 6-202(8), captioned, “Additional venue permitted,” provides:
“In addition to the venue provided in § 6-201 or § 6-203, the following actions may be brought in the indicated county:
“(8) Tort action based on negligence—Where the cause of action arose[J”

. The majority further holds "that pursuant to Section 6-201(a) of the Courts and Judicial Proceedings Article, venue is determined when suit is brought, and medical privileges and appointments in Baltimore City, such as in issue in the present case, alone, are insufficient to establish venue in Baltimore City.” 412 Md. at 186, 986 A.2d at 430.

. The Court was also presented with the issue as to whether the trial court erred in precluding the injured plaintiff, who, as a result of his injury, was essentially in a motionless vegetative state, unable either to communicate or to understand the proceeding, from being brought into the courtroom for a period of less than an hour during the two-weelc *222trial as to liability, to be exhibited to the jury "to demonstrate his current condition.”

. I did not agree with Green when it was decided—I dissented—and I continue to be skeptical of its accuracy. For purposes of this dissenting opinion, however, I accept its teaching. As I explain, infra, Green does not support the majority's analysis or the result it reaches.

. The majority apparently believes that the critical condition for the purpose of determining when injury occurred is Mrs. Burnside’s background diabetic retinopathy, the symptom of which simply progressively worsened. Thus, the majority disputes that Mrs. Burnside’s condition was asymptomatic, relying, for support, on Mrs. Burnside’s expert's affidavit that indicated that "she presented to Dr. Wong with symptoms of background diabetic retinopathy, from which proliferative retinopathy gradually progressed.” Burnside v. Wong, 412 Md. 206 n. 13, 986 A.2d 442 n. 13. But that is just the point, Mrs. Burnside, when misdiagnosed, was suffering from background diabetic retinopathy, not proliferative retinopathy, an aggravated form of diabetic retinopathy. Background diabetic retinopathy and proliferative diabetic retinopathy are different. Diabetic retinopathy "is divided into two groups: non-proliferative diabetic retinopathy consisting of blot, dot hemorrhages, exudate, and macular edema; and proliferative diabetic retinopathy consisting of abnormal new vessels and fibriotic tissue.” Taber's Cyclopedic Medical Dictionary 2027 (21st ed. 2005). Background diabetic retinopathy is "characterized by progression of microaneurysm, intraretinal punctate hemorrhages, yellow exudates, cotton-wool spots, and sometimes macular edema that can compromise vision.” Dorland’s Medical Dictionary 1659 (31st ed. 2007). Proliferative retinopathy, on the other hand, is "characterized by neovascularization of the retina and optic disk, proliferation of fibrous tissue, vitreous hemorrhage, and eventually retinal detachment with blindness.” Id. Background diabetic retinopathy is not listed as a characteristic of proliferative retinopathy. Much as the majority may want it to be so, a condition presently being suffered is not a symptom of an aggravated, progressive form of that condition; background *227diabetic retinopathy simply is not a symptom of proliferative retinopathy.
It is not surprising that Mrs. Burnside was displaying symptoms of background diabetic retinopathy. Similarly, it is not surprising, not to mention logical, that she was not displaying symptoms of proliferative retinopathy, a progression to which the condition she was suffering, gradually could, but need not, develop. The question is when did this process of gradual progression become an injury within the contemplation and meaning of Rivera v. Edmonds, supra and Oxtoby v. McGowan, 294 Md. 83, 447 A.2d 860?; when, in other words, did the symptoms of background diabetic retinopathy develop into symptoms of proliferative retinopathy? That question must answered in light of the fact that the diagnosis of Mrs. Burnside’s visual acuity following an April 8, 2002 office visit was that it was stable.
On another note, the majority’s protestations that this case involves, like Green, a symptomatic condition is concession that there is a difference in analysis and perhaps result, depending upon which— symptomatic or asymptomatic—the condition happens to be. If it is not a concession, one can only wonder why the majority bothers to raise the issue at all.