Dr. Waletzky filed a Motion to Dismiss, arguing that Ms. Lewis was required to comply with the requirements of the Healthcare Malpractice Claims Act (the “Act”). Ms. Lewis opposed the motion, claiming that she was not subject to the Act because her injury occurred in Washington, D.C. and, therefore, Maryland law did not govern her medical malpractice suit. The Federal district court dismissed Ms. Lewis’ case; however, on appeal, the Fourth Circuit determined that the choice of law issue involved a question of unresolved Maryland law. Thus, the Fourth Circuit certified the following question to the Court of Appeals: Does Maryland recognize the public policy exception, or any other exception, to lex loci delicti based on the Act, which requires a Plaintiff to comply with certain mandatory administrative filings prior to filing a medical malpractice suit?

The Act created the Healthcare Alternative Dispute Resolution Office (“HCADRO”) in order to establish and administer an arbitration process for medical malpractice claims prior to court action. Prior to filing a medical malpractice claim, the Act requires plaintiffs to file with the HCADRO. Within 90 days of filing a claim with the HCADRO, a plaintiff must also file a certificate of qualified expert. Strict adherence to the Act’s procedures is necessary to maintain a claim in circuit court, and the Maryland Court of Appeals has not hesitated to dismiss a claim for failure to comply with the Act.

In diversity actions, federal courts apply the substantive law of the state in which they sit. Maryland follows lex loci delicti, which states that the law of the place of injury governs all matters of substantive law. The law of the forum, however, governs all procedural matters. Thus, if the Act’s filing requirement is substantive, lex loci delicti controls, and absent invocation of the public policy exception, a Maryland court would not enforce the Act’s filing requirements. A Maryland court would require compliance, however, if the filing requirements are procedural. Procedural provisions of law generally “restrict, limit, define, qualify, or otherwise simply modify” an existing cause of action. Thus, procedural matters are simply those that affect the manner in which the forum administers justice.

The certificate of qualified expert requirement of the Act has been described as “an indispensable part of [the process to reduce the number of medical malpractice court suits] because it helps weed-out non-meritorious claims.” Though compliance with the Act’s filing requirements is condition precedent to maintaining a medical malpractice lawsuit, compliance in no way establishes, denies, or defines a cause of action. Rather, the filing pre-requisites are part of a legislative scheme intended to control the manner in which Maryland administers justice, by controlling access to Maryland courts. In fact, the plain language of the Act provides that, with the exception of Md. Code Ann., Cts. & Jud. Proc. §§ 3-2A-08A and 3-2A-09, “the provisions of this subtitle shall be deemed procedural in nature and may not be construed to create, enlarge, or diminish any cause of action not heretofore existing.” Md. Code Ann., Cts. & Jud. Proc. § 3-2A-10.

For these reasons, the Court found that lex loci delicti did not apply under the circumstances present in Ms. Lewis’s case. The filing requirements are procedural, mandating application of those requirements under Maryland’s choice of law rules, as the law of the forum. According, Ms. Lewis was required to comply with the Act’s filing requirements.