Common Defenses Raised by Health Care Providers
Published .
A provider’s answer to a malpractice claim may challenge the care, the causal link to the injury, the amount of damages, or the legal and procedural basis for the claim. The defenses depend on the records and expert evidence. A poor outcome alone does not prove negligence, but a defense label alone does not resolve the claim either.
No departure from the “standard of care”
The provider may contend that the care met the standard required of a reasonably competent practitioner in the same or a related specialty under the circumstances. Disputes often concern what information was available at the time, what risks were reasonably apparent, and whether the provider’s choices fell within an accepted range of practice. The standard is not simply whether another clinician would have acted differently.
No “causation” or another cause of the injury
A defendant may argue that the alleged lapse did not cause the injury, that the injury would have occurred even with appropriate care, or that another condition or event better explains it. These are usually expert questions. The analysis should connect the specific act or omission to the particular harm and account for preexisting conditions and other plausible causes.
Patient conduct and failure to follow instructions
Maryland follows contributory negligence, which can bar recovery when a plaintiff’s own negligence legally contributes to the injury. In medical-malpractice cases, however, the defense requires evidence tied to the patient’s conduct; a recent Maryland appellate opinion explained that the issue has been submitted to a jury only when evidence showed that the patient failed, or unreasonably delayed, to follow a treating provider’s instructions. A provider may also argue that later conduct increased the harm or that reasonable steps to limit the loss were not taken. Those arguments must be evaluated in light of the provider’s own duties, the patient’s condition, and what the patient was told.
Preexisting conditions and the amount of damages
The defense may contend that some symptoms, limitations, or treatment needs existed before the alleged malpractice or arose from another cause. It may dispute whether treatment was necessary, whether future care is reasonably certain, or whether claimed losses are supported by the records and expert opinions. A preexisting vulnerability does not by itself excuse a provider whose negligence worsened the patient’s condition. Statutory limits on noneconomic damages may also affect the amount recoverable; they are damages rules, not proof that the provider met the standard of care.
“Informed consent”
A claim that the provider failed to disclose material risks or alternatives raises an informed-consent issue distinct from whether the procedure was performed negligently. The provider may assert that adequate information was disclosed, that the patient agreed, or that the alleged nondisclosure did not cause the injury under the governing legal test. Emergency circumstances and other facts can affect the analysis. Maryland’s statutory expert-certificate exception for a claim whose sole issue is lack of informed consent is narrow; it does not automatically remove expert requirements from a case that also alleges negligent care.
Limitations, repose, and procedural requirements
A provider may assert that a claim was filed too late or that a required Maryland Health Care Alternative Dispute Resolution Office step was missed. Maryland generally requires a qualified-expert certificate addressing departure from the standard of care and proximate cause within 90 days after the claim or complaint is filed, subject to statutory exceptions and extensions. The certificate must be supported by the expert’s report. Medical-malpractice deadlines include special rules for minors, so the ordinary deadline should not be applied without checking the claimant’s age, injury, and claim type.
Expert qualifications and the scope of testimony
The defense may challenge whether an expert is qualified for the particular specialty or subject, whether the opinion is supported by a sufficient factual basis, or whether the expert is offering an opinion beyond the permissible scope. A disagreement between experts is not resolved by counting credentials alone; the court considers the governing qualification rules and the foundation for each opinion.
Responsibility of hospitals and other organizations
A hospital, practice, or other organization may dispute whether the clinician was its employee or agent, whether the conduct occurred within the scope of the relationship, or whether the organization itself had a duty and breached it. Claims based on credentialing, staffing, policies, supervision, or equipment require proof of the organization’s own responsibility and a causal connection to the injury. A finding that a clinician did not breach the standard can also defeat a claim that seeks to hold an organization vicariously liable for that clinician’s negligence.
Immunity and other statutory protections
Depending on who provided the care and in what capacity, a defendant may invoke governmental immunity, statutory damages limits, notice requirements, or another special protection. These rules are highly dependent on the provider’s legal status, the location and purpose of the care, and the identity of the proper defendant. The fact that care occurred at a public or publicly affiliated facility does not, by itself, answer those questions.
How to evaluate a defense
The useful questions are what facts support the defense, which expert opinions address it, whether it fits the governing Maryland rule, and whether it concerns liability, causation, damages, or procedure. Medical records, timelines, informed-consent materials, medication and monitoring records, policies, and testimony may confirm or undermine the defense. Early review matters because limitations and expert-certificate requirements can affect the case before the merits are tried.
Related Maryland Cases and Authorities
Md. Code, Cts. & Jud. Proc. §§ 3-2A-02, 3-2A-04, 5-109, 11-108; Reid v. Baltimore Ambulatory Center for Endoscopy, LLC, No. 2349, Sept. Term 2023 (App. Ct. Md. 2026); Landon v. Zorn, 389 Md. 206, 884 A.2d 142 (2005).