Third party negligence in medical malpractice cases: the quiet demise of res inter alios acta

July 6, 2013

Martinez ex rel. Fielding v. The John Hopkins Hosp., — A.3d —, 2013 WL 3337277 (Md. App. 2013)

Hospitals and doctors must take patients as they come. The patient’s condition at checking-in is the baseline for evaluating the propriety of the treatment she subsequently receives from her doctors. Prior negligence that brought about this condition – be it the patient’s or a third party’s negligence – is immaterial. Courts usually exclude evidence of such prior negligence under the “res inter alios acta” rule or under the general relevancy standard. See my discussion of this rule here, on pages 1223-24.

But things are not always that simple. There are cases in which prior third-party negligence is relevant and admissible for both malpractice and causation purposes. Martinez was one of those cases. There, a minor plaintiff, Enzo Martinez, sued the Johns Hopkins Hospital for alleged failure to perform a timely Caesarean section at his birth. This failure, claimed Martinez, was negligent and resulted in his cerebral palsy, retardation, and other disorders.

The hospital responded by claiming that Martinez’s mother had chosen to deliver him at home, with the assistance of a registered nurse midwife and a doula. This delivery didn’t go well, and when Martinez’s mother checked into the hospital, she already experienced serious complications. The hospital alleged that its doctors and staff did everything they could to resolve those complications, but did not succeed. According to the hospital, the midwife’s negligence was solely responsible for the plaintiff’s tragedy.

To prove this “third party negligence” defense, the hospital called in evidence from which the jury could learn about the specifics of the unsuccessful home birth delivery. This evidence aimed to show the jury that the midwife managed the delivery negligently. Pursuant to Martinez’s objection, the trial judge ruled that this evidence was inadmissible.

The Maryland Court of Appeals overturned that decision. The court reasoned that the evidence suppressed by the trial judge was potentially probative in two respects: (1) it could help the hospital show the jury that its staff treated the plaintiff’s mother properly, given the nature and origin of her complications; (2) it could causally disassociate the hospital and its staff from the plaintiff’s ailments by showing that they could not be prevented, given his mother’s condition at checking in and the circumstances of the failed home birth delivery. Hence, the evidence was admissible and its suppression constituted a reversible error.

This decision is unquestionably correct. It is also a well reasoned decision that references precedents from other state courts. Defendants will certainly use this decision as a handy citation.