For health care providers facing a medical malpractice suit, the recent decision in Canton Harbor Healthcare Center, Inc. v. Robinson, No. 22, Sept. Term, 2024, 2025 WL 2113185 (Md. July 29, 2025), changes the landscape of what to expect in court.
The Supreme Court of Maryland held that qualified registered nurses may author Certificates of Qualified Expert (CQEs) attesting to both breach of nursing standards and proximate cause in pressure ulcer cases, but only if the nurse meets “peer-to-peer” requirements and stays within the scope of nursing diagnosis.
The case involved a patient who developed pressure ulcers at a skilled nursing facility. The plaintiff’s CQE, authored by a registered nurse, detailed negligent nursing care and linked it to the injury. The circuit initially court dismissed the case, finding that the nurse had impermissibly strayed into medical diagnosis (i.e., issues of causation, which have long been “off the table” for nursing experts in Maryland). On appeal, however, the high court concluded that a nurse may opine on causation, as long as it is framed as a part of a nursing diagnosis related to nursing care, not broader medical determination.
What this means for defendants:
- Scope is Crucial: Opinions must remain within nursing diagnoses; nurses cannot offer medical diagnoses. If the plaintiff’s expert nurse strays into medical causation, the defense can challenge the testimony as outside the scope of nursing practice.
- Peer-to-Peer Rule Applies: The nurse must have relevant clinical experience within five years of the alleged negligence.
- Narrow Holding: Trial admissibility remains open to Daubert challenges.
Defense Strategies Moving Forward:
This ruling removes one avenue of early dismissal in pressure ulcer cases; it can no longer be argued that only physicians can certify on causation. For defendants, the focus must now shift to:
- Ensure the nurse’s opinions do not extend beyond nursing diagnosis
- Verify whether the nurse truly meets the “peer-to-peer” standard
- Raise timely objections to keep improper opinions out of evidence.
At Waranch & Brown, we recognize how this decision reshapes the defense playbook. We are committed to helping providers like you confront these expanded claims head-on, identify weaknesses in plaintiffs’ certificates, and build the strongest defense possible.