Background
On April 5, 2020—one month after Governor Lawrence Hogan declared a catastrophic health emergency due to COVID-19—James Smith, Jr. arrived at Upper Chesapeake Medical Center’s emergency room in acute respiratory failure. The hospital intubated him, placed him on a ventilator, admitted him to the ICU, and classified him as a Person Under Investigation (PUI) for COVID-19. Despite testing negative for COVID-19 on April 8 and April 11, the hospital kept him under elevated isolation and PPE protocols because his respiratory condition continued to deteriorate and clinical suspicion of COVID-19 or co-infection remained. He remained in PUI isolation status until April 22, 2020.
During this period, staff failed to reposition Smith every two hours as required to prevent skin breakdown. On April 14 a deep tissue injury was discovered on his sacrum. It progressed to an infected, unstageable decubitus ulcer requiring multiple debridement and skin-graft procedures over the following year and a half, leaving Smith permanently disabled. Smith and his wife sued Upper Chesapeake for negligence and loss of consortium, alleging the hospital’s failure to reposition him caused the injury.
Upper Chesapeake asserted immunity from civil liability under Md. Code, Public Safety Article § 14-3A-06, contending it had operated under an Emergency Response Plan directly tied to the Governor’s proclamation throughout Smith’s hospitalization. The hospital documented that PPE shortages, mandatory donning and doffing requirements for every patient contact, limited ICU staffing, and COVID-19 isolation protocols materially altered staff’s ability to deliver routine preventive care. The Circuit Court for Harford County granted summary judgment for the hospital, and Smith appealed.
The Court’s Holding
The Appellate Court of Maryland affirmed, holding that PS § 14-3A-06 immunizes healthcare providers for care rendered in good faith under a Governor’s emergency proclamation, without regard to whether the specific treatment provided was for the illness underlying the proclamation. The court rejected Smith’s argument that immunity evaporated the moment he tested negative for COVID-19 and his care became directed at other conditions. In the court’s reading, the statute conditions immunity solely on the provider’s good-faith response to the emergency proclamation and compliance with directives issued by the Secretary of Health—not on any required nexus between the patient’s diagnosis and COVID-19.
The court held that the Governor’s proclamation and the Secretary’s directives fundamentally altered the standard of care by which providers’ conduct is measured, recognizing that front-line hospitals were operating under a “critical crisis standard of care” in unprecedented conditions. Because Upper Chesapeake had adopted and was executing emergency protocols—including COVID-19 isolation policies, PPE conservation measures, and an ICU response plan—that responded directly to the declared emergency, and because the hospital’s modified protocols demonstrably affected every patient in the ICU (including Smith), the statutory immunity applied to the care at issue.
The court clarified, however, that PS § 14-3A-06 does not confer blanket immunity on all providers for all claims arising during a declared emergency. The inquiry remains fact-specific: immunity turns on whether the particular provider was actually operating in good faith under and in response to the emergency proclamation when the allegedly negligent care occurred. A provider conducting procedures wholly unrelated to and unaffected by the emergency would not automatically qualify.
Key Takeaways
- Maryland’s catastrophic health emergency immunity statute (PS § 14-3A-06) protects healthcare providers who act in good faith under a declared emergency proclamation even when the allegedly negligent care is not directed at the condition underlying the emergency—here, a pressure injury rather than COVID-19 itself.
- A patient’s negative COVID-19 test does not automatically terminate immunity; so long as the provider’s emergency protocols continued to affect care in good faith (e.g., continued PUI isolation due to unresolved respiratory status), immunity may persist.
- The immunity analysis is fact-specific: courts must examine the timing of care, the actual impact of the emergency proclamation on hospital operations, and whether the provider was genuinely operating under emergency-driven protocols—not whether the patient had the disease that prompted the proclamation.
- An agency interpretation limiting immunity (here, the Maryland Secretary of Health’s Amended Order regarding elective procedures) does not override the statute’s text and applies only within its own stated scope; it cannot redefine the statutory immunity threshold for care provided before its effective date or for emergency ICU settings.
Why It Matters
This decision is the first reported Maryland appellate opinion interpreting the scope of PS § 14-3A-06’s healthcare provider immunity in the context of COVID-19, and it sets a significant precedent for the wave of pandemic-era malpractice claims still working through Maryland courts. By anchoring immunity to the provider’s good-faith response to the emergency proclamation rather than to a patient-specific COVID-19 diagnosis, the court broadly protects hospitals and ICU staff who operated under pandemic-era crisis conditions—even where the alleged negligence involves routine preventive care like repositioning protocols.
For plaintiffs’ counsel, the ruling underscores that defeating emergency immunity will require demonstrating either that the provider was not actually operating under emergency-driven protocols, or that the provider did not act in good faith—a demanding factual showing. Defense attorneys can rely on this decision to argue that the institutional disruption caused by an emergency proclamation, not the individual patient’s diagnosis, is the operative question. Going forward, the decision also cautions that courts will scrutinize immunity claims on their specific facts, leaving open the possibility that providers who returned to normal operations before a patient’s care ended may lose immunity at that transition point.