Shilkret v. Annapolis Emergency Hospital Ass'n
276 Md. 187, 99 A.L.R. 3d 1119, 349 A.2d 245 (1975)
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Rule of Law:
In a medical malpractice action, the standard of care for both physicians and hospitals is that of a reasonably competent practitioner or facility in the same class, acting in the same or similar circumstances. This national standard replaces the outdated 'strict locality' rule, which limited the standard to the defendant's own community.
Facts:
- Mark Alan Shilkret was born at Anne Arundel General Hospital on December 22, 1968.
- During his delivery, Shilkret suffered intracranial bleeding which resulted in permanent brain damage.
- His mother had been treated throughout the prenatal stage by two defendant obstetricians, who also delivered the infant.
- A defendant anesthesiologist was present and attended to the mother and infant at birth.
- A defendant pediatrician examined the infant at the hospital the day after his birth.
- The alleged negligence occurred during the delivery and subsequent treatment by the defendant physicians and hospital staff.
- Anne Arundel General Hospital was accredited by the Joint Commission on Accreditation of Hospitals, a national body.
Procedural Posture:
- The Shilkrets (plaintiffs) sued the Anne Arundel General Hospital and several physicians (defendants) for medical malpractice in the Circuit Court for Anne Arundel County, a state trial court.
- At trial, the court ruled that the 'strict locality' standard of care applied.
- Because the plaintiffs conceded they could not meet this standard, the trial court granted the defendants' motions for a directed verdict.
- The Shilkrets (appellants) appealed to the Court of Special Appeals of Maryland, an intermediate appellate court.
- The Court of Special Appeals affirmed the trial court's judgment, holding that Maryland law required the application of the strict locality rule.
- The Shilkrets (petitioners) sought and were granted a writ of certiorari by the Court of Appeals of Maryland, the state's highest court, to review the question of the proper standard of care.
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Issue:
Does the standard of care for physicians and hospitals in a medical malpractice action depend on the 'strict locality' rule, which measures conduct against that of other professionals in the same community?
Opinions:
Majority - Levine, J.
No. The standard of care for physicians and hospitals in a medical malpractice action does not depend on the 'strict locality' rule; rather, it is based on what a reasonably competent practitioner or facility would do under similar circumstances. The historical justifications for the locality rules, such as protecting rural practitioners with limited access to information and technology, are no longer valid due to advances in medical education, communication, and transportation. The court explicitly abandons both the 'strict locality' and 'similar locality' rules, finding them obsolete and potentially unfair to patients. For physicians, the new standard is 'that degree of care and skill which is expected of a reasonably competent practitioner in the same class to which he belongs, acting in the same or similar circumstances.' For hospitals, the standard is 'that degree of care and skill which is expected of a reasonably competent hospital in the same or similar circumstances.' This unified, national standard allows for relevant factors like specialization and available facilities to be considered without being constrained by outdated geographical limitations.
Analysis:
This case marks a pivotal shift in Maryland's medical malpractice jurisprudence, officially abandoning the archaic 'strict locality' rule and aligning the state with the modern, majority trend toward a national standard of care. By doing so, the court recognized that standardized medical education and national board certifications have created a uniform baseline for competence that is not geographically dependent. This decision significantly impacts future malpractice litigation by making it easier for plaintiffs to secure expert testimony, as witnesses are no longer required to be from the defendant's community. The flexible 'same or similar circumstances' language ensures the standard remains fair to practitioners in various settings by allowing juries to consider available resources, while still holding them accountable to contemporary, national medical standards.
