Lockshin v. Semsker

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Norman A. Lockshin, M.D., P.A., et al. v. Barbara S. Semsker, individually and as personal representa tive of the estate of Richard H. Sem sker, et al., No. 78, September Term 2009 CIVIL PROCEDURE - HEALTH CARE MALPRACTICE CLAIMS - NON-E CONO MIC DAMAGES CAP - THE PL AIN MEANING OF MARYLAND CODE, COURTS AND JUDICIAL PROCEEDINGS ARTICLE § 3-2A-09(a), WHICH STATES THAT THE NONECON OMIC DAMAGES CAP FOR HEALTH CARE MALPRACTICE CLAIMS CONTAINED IN § 3-2A-0 9(b) APPL IES TO A VERD ICT UN DER § 3 -2A-06 OF THIS SUB TITL E, PROVIDES THAT THE CAP APPLIES TO ALL HEALTH CARE MALPRACTICE CLAIMS BROUGHT UNDER SUBTITLE 3-2A, INCLUDING THOSE FOR WHICH ARBITRATION HAS BEEN WAIVED PURSUANT TO §§ 3-2A-06A OR 3-2A-06B. Circuit Co urt for Mo ntgomery C ounty Case No . 28367 4-V IN THE COURT OF APPEALS OF MARYLAND No. 78 September Term, 2009 NOR MAN A. LO CKSH IN, M.D ., P.A., et al. v. BARBAR A S. SEMSKER , individually and as personal representative of the estate of RICH ARD H. SEM SKER , et al. Bell, C.J. Harrell Battaglia Greene Murphy Adkins Barbera, JJ. Opinion by Harrell, J. Filed: January 12, 2010 The Circuit Co urt for M ontgom ery County held in this litigation, among other things, that the plain m eaning of Md. C ode, Cou rts & Judic ial Proceed ings Article 1 § 3-2A-09(a) (1974, 2006 Repl. Vol.), which states that the monetary cap on non-economic damages for health care malpractice claims appearing in § 3-2A-09(b) applies to an award under § 3-2A05 of this subtitle or a verdict under § 3-2A-06 of this subtitle, is that the cap is inapp licable to claims for which ar bitration is waived pursuant to §§ 3-2A-06A or 3-2A-06B. The latter provisions provide the procedures for mutual and unilateral waiver of arbitration, resp ectiv ely. Appe llants/C ross-Pe titioners ( Norm an A. L ocksh in, M.D ., P.A., and Dr. Michael Albe rt) urge this Court to reach a different conclusion under the plain meaning of the statute or, alternatively, to find ambiguity in the language of § 3-2A-09(a) and to examine the legislative history of th e statute, wh ich they mainta in supports th e conclusio n that the General Assemb ly intended the non-econo mic damages c ap to apply to all health care malpractice claims, not just those that are arbitrated. Appellees/Petitioners (the Estate of Richard H. Semsker, Barbara S. Semsker, Meryl Semsker, and Julia Semsker), on the other hand, maintain that the Circuit Court correctly determined the plain mean ing of § 3-2A -09(a). For reasons we shall explain, although we agree with the Circuit Court s conclusion that the language in § 3-2A-09(a) is plain, unlike the Circuit Court, we hold that the plain meaning of that language provide s that the cap on non-e conomic damages app lies to all health care malpractice claims, in cluding those, lik e the pre sent cas e, for which arbitration has been 1 All citations to the M aryland Cod e contained herein refe r to the Cou rts and Judicial Proceedings Article, unless otherwise noted. waived under § 3-2A-06B. I. The Statutory Scheme Governing Health Care Malpractice Claims As it illuminates an d informs our later ana lysis, it is desirable to fram e early in this opinion the relevant statutory scheme in which the question at hand is enmeshed. Subtitle 3-2A of the Courts and Judic ial Proceed ings Article governs n early all claims brought by plaintiffs against health care providers for medical injuries alleged to have been suffered by the pla intiffs a t the han ds of th e provi ders. § 3 -2A-0 2(a)(1) . The subtitle establishes the Health Care A lternative Dispute Resolu tion Office (the HCADRO ) and empowers it to create panels consisting of attorneys, health care providers, and members of the public to serve, prior to litigation, as arbiters of health care malpractice claims. §§ 3-2A03(a) and (c). Under this arbitration scheme, a plaintiff must file initially his or her claim, along with a certific ate of a qu alified expe rt attesting to the a lleged departure by the defendant(s) from standards of care and causation of the plaintiff s injury by such departure, with the Director of the HCADRO , who then refers the claim to an arbitration panel. §§ 32A-04(a)(1)(i), -04(b)(1)(i), and -05(a)(1). The arbitration panel reviews pertinent documents, takes testimony from the parties and their respective experts, determines the liability of the defendant or defend ants, if any, 2 assesses costs of the arbitration, and issues 2 Section 3-2A-05(e), entitled Determinations, provides: (1) The arbitration panel shall first determine the issue of liability with respec t to a claim ref erred to it. (contin ued...) -2- an award . § 3-2A-05(b)-(f). Following the panel s award determination, any party may apply to the arbitration panel to modify or correct its award as to liability, damages, or costs. § 3-2A-05(h). Under § 3-2A-06(a), a party may reject an award or the assessment of costs under an award for any reason by notifying the Director, the arbitration panel, and the other parties to the dispute, and by filing an action in the Circuit Cou rt to nullify the award or assessment of costs. §§ 3-2A-06(a) and (b)(1). Upon proper rejection of the arbitration panel s award, any party may elect to have the case tried by a jury in the C ircuit Court; if n o party elects timely a trial by jury, the case is heard before a judge. § 3-2A-06(b)(2). At the c lose of th e tria l and upon tim ely req uest, the t rier o f fac t shall by s pecial verdict or specific findings itemize by category and amount any damages assessed for 2 (...continued) (2) If the arbitration panel deter mines that the health care provider is not liable to the claimant or claimants the award shall be in favor of the he alth care provider. (3) If the arbitration panel determines that a health care provider is liable to the claimant or claimants, it shall then consider, itemize, assess, and apportion appropriate damages against one or more of th e health care providers th at it has found to be liable. (4) The award shall itemize by category and amount any damages assessed for incurred medical expenses, rehabilitation costs, and loss of earnings. Damages assessed for any future expense s, costs, and lo sses shall be it emiz ed se para tely. § 3-2A-05(e). -3- incurred medical expenses, rehabilitation costs, and loss of earning s. § 3-2A-06(f)(1). 3 The 3 Section 3-2A-06(f), entitled Itemization of certain damages; remittur, provides: (1) Upon tim ely request, the trier of fact shall by special verdict or specific fin dings itemiz e by category and amount any damages assessed for incurred medical expenses, rehabilitation costs, and loss of earnings. Damages assessed for any future expenses, costs, and losses shall be itemized separately. If the verdict or findings include any amount for such expenses, costs, and losses, a party filing a motion for a new trial m ay object to the damages as excessive on the ground that the plaintiff has been or will b e paid, reimbursed, or indemnified to the extent and subject to the limits stated in § 3-2A-05(h) of this subtitle. (2) The court shall hold a hearing and receive evidence on the objection. (3)(i) If the court finds from the evidence that the damages are excessive on the grounds stated in § 3-2A-05(h) of this subtitle, subject to the limits and conditions s tated in § 3-2 A-05(h) of this subtitle, it may grant a new trial as to such damages or may deny a new trial if the plaintiff agrees to a remittur of the excess and the orde r required adequate secur ity when warranted by the conditions stated in § 3-2A-05(h) of this subtitle. (ii) In the even t of a new trial granted un der this subsection, evidence considered by the court in granting the remittur sh all be adm issible if offered at the new trial and the jury shall be instru cted to consider such evid ence in reaching its verdict as to damages. (iii) Upon a determination of those damages at the new trial, no further o bjection to damages may be made ex clusive of a ny party s right to app eal. (4) Except as expressly provided by federal law, no person may recover from the plaintiff or assert a claim of subrogation against a defendant for any sum included in a remittur or (contin ued...) -4- special verdict shall itemize separately any damages for any future expenses, costs, and losses. Id. If a verdict includes any such itemized damages for expenses, costs, and losses, a party may object to the damages as excessive on the ground that the plaintiff has been or will be paid, reim bursed, or in demnifie d to the exte nt and sub ject to the limits stated in § 32A-0 5(h) . . . . 4 Id. If, after reception of evidenc e on the objection at a hea ring, the court 3 (...continued) awarded in a new trial on dam ages gran ted under th is subsection. (5) Nothing in this subsection shall be construed to otherwise limit the common law grounds for rem ittur. § 3-2A-06(f). 4 Section 3-2A-05(h), entitled Application for modification or correction; request for reduction of damages, provides: (1) A party may apply to the arbitration panel to modify or correct an award as to liability, damages, or costs in accordance with § 3-222 of this title. (2)(i) The application may include a request that damages be reduced to the extent that the claimant has been or will be paid, reimbursed, or indemnified under statute, insurance, or contract for all or part of the damages assessed. (ii) The panel chairman shall receive such evidence in support and opposition to a request for reduction, including evide nce of the cost to obtain such payment, reimburs emen t, or inde mnity. (iii) After hearing the evidence in support and opposition to the request, the panel chairman may modify the award if satisfied that modifica tion is supported by the evidence. (contin ued...) -5- 4 (...continued) (iv) The award may not be modified as to any sums paid or payable to a claimant under any workers compensation act, criminal injuries compensation act, employee benefit plan established under a collective bargaining agreement between an employer and an employee or a group of em ployers and a group of employees that is subject to the provisions of the federal Employee Retirement Income Security Act of 1974, program of the Department of Health and Mental Hygiene for which a right of subrogation exists under §§ 15-120 and 15-121.1 of the Health - General Article, or as a benefit under any contract or policy of life insurance or Social Security Act of the United States. (v) An award may not be modified as to any damages assessed for any future expenses, costs, and losses unless: 1. The panel chairman orders the defendant or the defendant s insurer to provide adequate security; or 2. The insurer is authorized to do business in this State and maintains reserves in compliance with rules of the Insuran ce Com missioner to assure the paymen t of all such future damages up to the amount by which the award has been modified as to such future damages in the event of termination. (vi) Except as expressly provided by federal law, no person may recover from the claimant or assert a claim of subrogation against a defendant for any sum included in the modification of an award. (contin ued...) -6- finds that the dam ages are ex cessive on the grounds stated in § 3-2 A-05(h) , it may grant a new trial as to such damages or may deny a new trial if the plaintiff agrees to a remittur of the excess. § 3-2A-0 6(f)(3)(i). The arbitration process, how ever, may be avoided in the main. Under § 3-2A-06A, at any time prior to the hearing of a claim by the HCADRO, the parties may agree mutually to waive arbitration of the claim. § 3-2A-06A(a). If the parties so agree, the provisions of [§ 3-2A-06A] then shall govern all further proceedings on the claim. Id. Where a case is subject to the provisions of § 3-2A-06A based on mutual waiver of arbitration , the statute provides that the proced ures of § 3-2A -06(f) of this subtitle shall apply. § 3-2A-06 A(e). In addition to mutual waiver under § 3-2A-06A, arbitration of a claim through the HCADRO may be waived by the claimant or any defendant in accordance with § 3-2A06B after the filing of the certific ate of qualified expert required by § 3-2A-04(b). §§ 3-2A06B(a) and (b)(1). If arbitration is w aived unila terally in this fashion, the provisions of [§ 3-2A-06B] shall govern all further procee dings o n any claim . . . . § 3-2A-0 6B(a). A s with mutual waiver of arbitration under § 3-2A-06A, where a case is waived unilaterally out of arbitration, the statute provides that the procedu res of § 3-2 A-06(f) o f this subtitle sha ll apply. § 3-2A-06B (h). Of particular importance to the prese nt case, § 3-2A-0 9, entitled Limitation of 4 (...continued) § 3-2A-05(h). -7- nonecon omic damages, prov ides a cap on non -economic dam ages applicable to an aw ard under § 3-2A -05 of this subtitle or a verdict unde r § 3-2A-06 of this subtitle for a cause of action arising on or after January 1, 2005. § 3-2A-09(a). Subsection (b) establishes the amount of the cap, stating that an aw ard or verdict under this su btitle for non econom ic damages for a cause of action arising between January 1, 2005, and December 31, 2008, inclusive, may not excee d $650 ,000. § 3-2A -09(b)( 1)(i). The limitatio n on non -econom ic damages contained in § 3-2A-09(b)(1)(i) increases by $15,000 yearly, beginning on 1 January 2009. § 3-2A-09(b)(1)(ii). In general, the cap applies in the aggregate to all claims for personal injury and wrongful death arising from the same medical injury, regardless of the number of claim s, claimants, plaintiffs, beneficiaries, or defendants. § 3 -2A-09(b)(2)(i). The statute furthe r provides th at, where there is a wrong ful death a ction in which there are two or more claimants or beneficiaries, whether or not there is a personal injury action arising from the same medical injury, the total amount awarded for noneconomic damages for all actions may not exc eed 125% of the limitation establish ed under paragraph (1) of this subsection, regardless of the number of claims, claimants, plaintiffs, beneficiaries, or defendants. § 3-2A -09(b)(2)(ii). Regarding the limitation on non-eco nomic da mages, § 3 -2A-09 s tates that a jury may not be informed of the limitation under § 3-2A -09(b). § 3-2A-09(c)(1). If the jury awards an amount for non-economic damages exceeding the limitation, the statute provides that the court shall reduce the amou nt to conform to the limitation. § 3-2A-09(c)(2 ). In a case in -8- which there is a pers onal injury action and a w rongful d eath action, if the total amount awarded by the jury for noneconomic damages for both actions exceeds the limitation under [§ 3-2A-09 (b)], the court s hall reduce the award in each actio n proportio nately so that the total award for noneconomic damages for both actions conforms to the limitation. § 3-2A09(c)(4). Lastly, § 3-2A-09(d) provides that a verdict for past medical expenses shall be limited to: (i) [t]he total amount of past medical expenses paid by or on behalf of the plaintiff; and (ii) [t]he total amount of past medical expenses incurred but not paid by or on behalf of the plaintiff for which the plaintiff or another person on be half of the plaintiff is obligated to pay. § 3-2A-0 9(d)(1). II. The Present Case In late 199 8, Rich ard H. S emske r, a 44-yea r-old R ockville attorney, visited the dermatology offices of Norman A. Lockshin, M.D., P.A. ( Lockshin, P.A. ), a medical group operating under the trade name Derm Associates, P.C., in Silver Spring, upon referral from his internist, Dr. Lawrence Marcus. Semsker was seen by Dr. Norman A. Lockshin, who removed a cyst and w rote to Dr. Marcus that Semsker had a dark brown 6 millimeter nevus5 on his back that should be excised. According to Semsker, neither D r. Marcus nor D r. Lockshin informed him of the presence of the nevus. In Septem ber 200 4, Sem sker retu rned to Lockshin, P.A . to have cysts on his upper 5 A nevus is [a] circumscribed malformation of the skin, especially if colored by hyperpigmentation or increased vascularity. PDR Me dical Dictionary 1208 (1st ed. 1995). -9- back exam ined and to un derg o a fu ll body skin check. He was examined by Dr. Michael Albert, a dermatologist employed by Lockshin, P.A., who documented two benign cysts, an atypical nevus on Sem sker s upper right back, and a 1.3 centime ter congen ital nevus on his lower back (the same ne vus that had grow n from 6 millimeters w hen Dr. Locksh in examined it in 1998). Dr. Albert recommended removal of the cysts and the atypical nevus, but recommended only regular monitoring of the congenital nevus, rather than its removal. As recommended, the upper-back cysts and atypical nevus were removed. On 3August 2006, shortly after Semsker s wife, Barbara, noticed that the nevus Dr. Albert had not recommended be removed had changed color, Semsker returned to Lockshin, P.A., where the nevus was excised by Dr. Benjamin Lockshin. Shortly afterward, it was determined that the nevus had turned into a malign ant melan oma w hich had m etastasized to dozens of lymph nodes in S emsker s groin and lower abdomen. Radiation and other treatment failed to halt further metastasis. On 30 Ma rch 2007 , Semske r and his wife filed with the Director of the HCADRO a claim under § 3-2A-04(a)(1)(i) for medical malpractice ag ainst Dr. Albert (Semsk er s dermatologist); Lockshin, P.A. under its business name Derm Associates, P.C. (Dr. A lbert s employer); Dr. Norm an Lock shin; Dr. K endall Hash (another employee of Lockshin, P.A .); and Dr. Marcus (Semsker s internist), alleging misdiagnosis of his cancer. Mr. and Mrs. Semsker elected to waive arbitration pursuant to § 3-2A-06B(b)(1) on 19 June 2007, and, one day later, filed in the Circuit Court for Montgomery County a complaint for medical -10- malpractice. In the plaintiffs Joint Pretrial Statement and a Supplement thereto, it was stipulated that they were claiming th e maxim um allow able und er the non-e conomic dama ges cap , whic h is $81 2,500. 6 On 15 October 2007, while the c ase was p ending in th e Circuit C ourt, Semsker passed away due to his cancer. On 19 December 2007, Mrs. Semsker filed a Second Amended Comp laint, converting the case to a wrongful death and survival action on behalf of Semsker s estate (for which she is the personal representative) and adding the Semskers two adult daughters, Meryl and Julia Semsker, as plaintiffs. Prior to trial, the remaining Sem skers dismiss ed volu ntarily and with pr ejudice all claim s again st Dr. H ash. The trial was conducted before a jury beginning on 3 November 2008. At trial, the Semskers introdu ced, w ithout o bjection , evidence of $415,781 in incurred medical expenses.7 On the final day of trial, following the conclusion of the evidence, the Semskers reached a joint tortfeaso r settlement w ith Dr. Marcus in the amount of $1 million and granted 6 Under § 3-2A-09(b)(2), the then current limit for recovery of non-economic damages in a wrong ful death h ealth care malp ractice case w ith multiple cla imants was $ 812,50 0. § 3-2A-09(b)(2). 7 The Semskers admit that, of the $415,781 for incurred medical expenses, they and their insurers paid on ly $335,5 68.15. T hus, acc ording to the S emske rs, the tota l write- off, calculated as the difference between the incurred bills and the amounts actually paid by all sources, was $80,213. Appellants/Cross-Petitioners, on the other hand, maintain that the write-offs by Semsker s health care p roviders totaled more than $200,000. The Semskers dispute that conten tion, arguin g that the Physicians assume erroneously that the insurance subrogation lien of $218,396 include d all bills paid by insurance and that, in fact, the insurers paid $112,572 in pharmacy bills for Semsker which were not part of the subrogation lien. No fact-finder has determined yet the amount of any write-offs. -11- Dr. Marcus a standard non-Swigert joint tortfeasor release.8 The purpose of the joint tortfeasor relea se w as to prov ide a n automatic c redit to an y non-settling defendants who were held liable ultimately to the Semskers in the present case, thus protecting Dr. Marcus from all future claims against him for contribution from non-settling joint tortfeasors. The release described the credit as an automatic reduction of any future verdict or judgment against any non-settling tortfeasor of all damages . . . recoverable by the Semskers to the extent of the pro rata share[] of [Dr. M arcus] or pro tanto, whichever is greater. On 14 November 2008, the jury returned a special verdict in favor of the Semskers, finding Dr. Albert liable individually for med ical malpractice. In its verdict, the jury awarded the Semskers $5,805,000 in compensatory damages, which included a total of $3 million in non-economic damages, allocated as follows: $1 million to Semsk er s estate, $1 million to Mrs. Semsk er, and $500,000 to each of the Semskers daughters.9 The verdict was applied by stipulation to Dr. Albert s employer, Lockshin, P.A., on a respondeat superior basis.10 8 A non-Swigert release, referring to our decision in Swigert v. W elk, 213 Md. 613, 133 A.2d 428 (1957), establishes joint tortfeasor status of the settling defendant and requires the plaintiff to credit against a judgment the greater of the settleme nt amoun t or a pro rata share of th e judgme nt. 9 The jury also awarded economic damages in the amount of $2 million to Mrs. Semsker for loss of fina ncial su pport, $300,000 to M rs. Semske r for loss of h ousehold services, $500,000 to Se msker s es tate for past m edical expe nses, and $ 5,000 to the estate for funeral expenses. 10 The jury found Dr. Norman A. Lockshin, the owner of the professional association (contin ued...) -12- On 18 November 2008, the Semskers moved the Circuit Court for entry of judgment on the entire jury verd ict, specifically requ esting that the court not ap ply the § 3-2A-09 cap on non-economic damages. The court entered judgment on the jury verdict on 19 November 2008. Subsequ ently, the defen dants fou nd liable by the jury, Dr. Albert and Lockshin, P.A. (collectively the Physicians ), u rged the co urt in a timely mo tion to apply the cap on noneconom ic dama ges con tained in § 3-2A -09(b) to the verd ict, to reduce the award for past medical expenses to account for those expenses that had been written off, and to conform the verdict to the evidence. The court, in that moment being of the view that the cap on noneconom ic damage s applied to the case, reduced the cumulative non-economic damages by the sum of $2,177 ,500, i.e., from $3 m illion to a total of $812 ,500, the cap limit for noneconom ic damages in wrong ful death h ealth care m alpractice ca ses with multiple claimants, and entered revised judgments on that amount on 26 Novemb er 2008.11 The court also reduced the award for past medical expenses from $500,000 to $415,871 in orde r to conform to the evide nce presen ted at trial. The Semske rs moved the Circuit C ourt, on 1 D ecembe r 2008, to alter or amend the judgmen t, arguing that the cap on non-economic damages did not apply to unarbitrated 10 (...continued) bearing his name, not liable to the Semskers. 11 As the result of the 26 November reductions, the judgment for non-e conomic damages was as follows: $270,833.34 to Semsker s estate, $270,833.34 to Mrs. Semsker, and $135,416.66 to each of the S emske rs two daugh ters. Th us, at this point, the total awards were: $2,570,83 3.34 to Mrs. Semsker, $135,416.66 to each of the Semskers daughters, and $691,614.64 to Semsker s estate. -13- claims. The Ph ysicians filed motions requesting a new trial, remittur, and revision of the judgmen ts based on application of the pro rata reduction called for by the release between the Semsk ers and Dr. M arcus. On 20 April 2009, the Circuit Court issued an order and opinion holding that, under the purportedly clear language of § 3-2A-09(a), the cap on noneconom ic damages contained in § 3-2A-09 did not apply to the present case b ecause it involved an unarbitrated claim, denying the Physicians motion for a new trial or remittur, and revising the judgmen t to reflect Dr. Marcus s pro rata joint tortfeasor contribution. In addition, the court, assuming hypothetically that the cap applied to unarbitrated claims, held that any pro rata reduction based on the joint tortfeasor settlement should be calculated prior to application of the cap, and that the Semskers could recover for past medical expenses that had been w ritten off by M r. Semske r s health care providers d ue to the Physicians failure to adduce a t trial any evidenc e of such write-off s. On 24 April 2009, the C ircuit Court entered four judg ments 12 in favor of the Semskers, in accordance with its 20 A pril order and opinion, effectively reinstating the amount of the award granted by the jury in its special verdict. 13 The Semskers and the Physicians petitioned this Court for a writ of certiorari, prior to final action o n an appe al to the Court of Special Appeals. We granted their petitions, 409 12 The judgments were revised, by the parties consent, on 5 June 2009. 13 Following its action on the parties motions, the court noted judgments in the amount of $1,650,000 to Mrs. Semsker, $250,000 to each of the Semskers daughters, and $710,436 to the estate. -14- Md. 413, 975 A.2d 875 (2009 ), to consider the following questions: (1) Whether the Circuit Court erred in holding that the cap on non-eco nomic damages in health care malpractice claims contained in § 3-2A-09 does not apply to health care malpractice claims in which arbitration has been waived under §§ 3-2A-06A or 3-2A-06B? (2) Whether the Circuit Court erred in holding that, if the cap does apply to claims in which arbitration has been waived, the court should apply a pro rata joint tortfeasor reduction prior to applying the limitation on non-economic damages? (3) Whether the Circuit Court erred in holding that § 3-2A09(d)(1) does not mandate a reduction of the verdict to exclude past medical ex penses tha t were no t, and will not be paid by or on behalf of, the patient, where the Physicians failed to offer evidence of those ex penses at trial? As the issues are solely questions of statutory interpretation, and, thus, questions of law, our review is non-d eferen tial. See Ha rvey v. M arshall, 389 Md. 243, 257, 884 A.2d 1171, 1179 (2005); Davis v. Slater, 383 Md. 599 , 604, 861 A.2d 7 8, 80-81 (2004); Liverpool v. Baltimore Diamond Exchange, Inc., 369 Md. 304 , 310, 799 A.2d 1 264, 1267 (200 2). III. Applicability of the Cap to Unarbitrated Health Care Malpractice Claims Basing its decision on what it believed to be the plain meaning of § 3-2A-09(a), the Circuit Court held that the non-economic damages cap of § 3-2A-09 did not apply to the present unarbitrated case because § 3-2A-09(a), wh ich states that the cap is applic able to awards under § 3 -2A-05 a nd verdicts under § 3 -2A-06, m akes no re ference to §§ 3-2A-06A or 3-2A-06B, the separate and distinct sections governing waiver of arbitration. Although finding the language in § 3-2A-09(a) plain in its meaning, the trial court nevertheless -15- reviewed the purpo se and legislative history of § 3 -2A-09( a), conclud ing (1) that its interpretation of § 3-2A-09(a) did not conflict with the statute s purpose paragraph14 because the statute as interpreted does impose a single restriction on awards a pplicable to b oth wrongful death and survival actio ns in certain medical malpractice claims, and (2) that applying the cap to unarbitrated claims would essentially reinstate the language of § 3-2A09 that was specifically deleted and amended by the Gene ral Assem bly when it enacted the final version of the b ill. 15 We agree with the Circuit Court that the language of § 3-2A-09(a) is plain. For reasons we shall explain, however, we disagree as to the plain meaning of that language and hold th at the plain meaning of the reference in § 3-2A-09(a) to a verdict under 14 In pertinent pa rt, the Purpose paragraph of the enacted version of House Bill 2, the Maryland Patients Access to Quality Health Care Act of 2004, states that the bill was intended for the purpose of: . . . altering certain limitations on noneconomic damages for health care malp ractice action s; establishing a single limitation on nonecon omic damages for a survival action and a wrongful death action concerning health care malpractice; prohibiting a jury from being informed of certain limitations on none conomic damages; requiring that an a ward or v erdict of eco nomic damages for a medical injury exclude certain amounts for past medic al expe nses . . . 2004 Md. Laws (Spec. Sess.), ch. 5, at 29. 15 During the first and second readings of House Bill 2, the proposed language of § 32A-09(a) provided: This section applies to a judgment under this subtitle for a cause o f action arising o n or afte r Janua ry 1, 2005 . -16- § 3-2A-06" includes verdicts in cases that arrive in a Maryland courthouse following a waiver of arbitration pursuant to §§ 3-2A-06A or 3-2A-06B. A. Pertinent Principles of Sound Statutory Construction The cardinal rule of statuto ry interpretation is to ascertain and effectuate the real and actual intent of the Leg islature. Bd. of Educ. v. Zimmer-Rubert, 409 Md. 200, 214, 973 A.2d 233, 241 (200 9); In re Najasha B., 409 Md. 20, 27, 972 A.2d 845, 849 (2009 ). A court s primary goal in interpreting statutory language is to discern the legislative purpose, the ends to be accom plished, or the evils to be remed ied b y the statut ory pr ovis ion u nder scru tiny. Anderson v. Council of Unit Owners, 404 Md. 560, 571, 948 A.2 d 11, 18 (2 009); People s Ins. Counsel Div. v. Allstate Ins. Co., 408 Md. 336 , 351, 969 A.2d 9 71, 979-80 (200 9); Barbre v. Pope, 402 M d. 157, 172 , 935 A.2d 699, 708 (2007); Dep t of Health & Mental Hygiene v. Kelly, 397 Md. 399 , 419-20, 918 A.2d 470, 482 (2007); Gen. Motors Corp. v. Seay, 388 Md. 341 , 352, 879 A.2d 1 049, 1055 (200 5). To ascertain the intent of the General Assembly, we begin with the normal, plain meaning of the language of the statu te. Zimmer-Rubert, 409 Md. at 214, 973 A.2d at 241; Allstate, 408 Md. at 351, 969 A.2d at 980; Anderson, 404 Md. at 57 1, 948 A .2d at 18; Allen v. State, 402 Md. 59, 76, 935 A.2d 42 1, 431 (20 07); Barbre, 402 Md. at 172, 935 A.2d at 708; Kelly, 397 M d. at 420, 91 8 A.2d a t 482. If the lan guage of the statute is unambiguous and clearly consistent with the statute s apparent purpose, our inquiry as to legislative intent ends ordinarily and we apply the statute as written, wit hout resort to other rules of -17- construction. Zimmer-Rubert, 409 M d. at 214-15 , 973 A.2d at 241-42 ; In re Najasha B., 409 Md. at 27, 972 A .2d at 849; Allstate, 408 Md. at 351, 969 A.2d at 980; Anderson, 404 Md. at 572, 948 A.2d at 19 ; Barbre, 402 Md. at 174, 935 A.2d at 708-09 ; Kelly, 397 Md. at 419, 918 A.2d at 482. We neither add nor delete language so as to reflect an intent not evidenced in the plain and unambiguous language of the statute, and we do not construe a statute with forced or subtle interpretations that limit or ex tend its applica tion. Lonaconing Trap Club, Inc. v. Dep t of Env t, 410 Md. 326 , 339, 978 A.2d 7 02, 709 (2009); Liverpool, 369 Md. at 316-17, 799 A.2 d at 1271 ( 2002); Curran v. Price, 334 Md. 149, 172, 638 A.2d 93, 105 (1994); Amal. Cas. Ins. Co. v. Helms, 239 M d. 529, 5 35, 212 A.2d 3 11, 316 (1965 ). We, however, do not read statutory language in a vacuum , nor do w e confine strictly our interpretation of a stat ute s pla in langu age to th e isolate d sectio n alone . Anderson, 404 Md. at 572, 948 A.2d at 19; Drew v. First Guar. Mort. Corp., 379 Md. 318, 327, 842 A.2d 1, 6 (2003); Blondell v. B alt. City Police Dep t , 341 Md. 680 , 691, 672 A.2d 6 39, 645 (1996); Comptroller v. John C. Louis Co., 285 Md. 527, 538, 404 A.2d 1045, 1052-53 (1979). Rather, the plain language must be v iewed w ithin the con text of the sta tutory scheme to which it belongs, considering the purpose, aim, or policy of the Legislature in enacting the statute. Anderson, 404 M d. at 572, 94 8 A.2d a t 19; Comp troller v. Phillips, 384 Md. 583, 591, 865 A.2 d 590, 59 4 (2005); Harvey, 389 Md. at 290, 884 A.2d at 1199; Blondell, 341 Md. at 691, 672 A.2d at 645. We presume that the Legislature intends its enactments to operate together as a consistent and harmonious body of law, and, thus, we seek to reconcile -18- and harmonize the parts of a statute, to the extent possible consistent with the statute s object and sco pe. Harvey, 389 Md. at 290, 884 A.2d at 1199; Liverpool, 369 Md. at 316-17, 799 A.2d at 1271; Curran, 334 Md. at 172, 638 A.2d at 104; John C. Louis Co., 285 Md. at 53839, 404 A.2d at 1053. Where the words of a statute are am biguous a nd subjec t to more tha n one reas onable interpretation, or where the words are clear and unambiguous when viewed in isolation, but become ambiguous when read as part of a larger statutory scheme, a court must resolve the ambiguity by searching for legislative intent in other indicia, including the history of the legislation or other relevant sources intrinsic and extrinsic to the legislative process. In re Najasha B., 409 Md. at 27, 972 A.2d at 84 9; Allstate, 408 Md. at 351, 969 A.2d at 979-80; Anderson, 404 Md. at 57 2, 948 A .2d at 19; Barbre, 402 Md. at 17 3, 935 A .2d at 709; Kelly, 397 Md. at 419-20, 918 A.2d at 482. In resolvin g amb iguities, a court considers the structure of the statute, how it relates to other laws , its general pu rpose, and the relative ratio nality and legal effect of variou s comp eting co nstructio ns. In re Najasha B., 409 Md. at 27, 972 A.2d at 849; Liverpool, 369 Md. at 316-17, 799 A.2 d at 1271; Chesapeake Charter, Inc. v. Bd. of Educ., 358 M d. 129, 135 , 747 A.2d 625, 628 (2000); Curran, 334 Md. at 172, 638 A.2d at 104. In every case, the s tatute must b e given a re asonable in terpretation, no t one that is absurd, illogical, o r incom patible w ith com mon se nse. Zimmer-Rubert, 409 Md. at 214, 973 A.2d at 241; Anderson, 404 Md. at 571, 948 A.2d at 18; Barbre, 402 Md. at 172, 935 A.2d -19- at 708. B. What is the Plain Meaning of § 3-2A-09(a)? Section 3-2A-09(a) provides that the non-economic damages cap for health care malpractice claims is applicable to an award under § 3-2A-05 of this subtitle or a verdict under § 3-2A-06 of this subtitle. § 3-2A-09(a). Subsection (a) makes no mention of § 32A-06A or § 3-2A-06B, the sections govern ing the p rocedu res for w aiving a rbitration . The Semskers contend, and the Circuit Court found, that the omission of such mention from subsection (a) of the arbitration provisions of §§ 3-2A-06A and 3-2A-06 B must m ean that, where arbitration has been waived, the cap on non-e conomic damages does not apply. They are mistaken. A health care malpractice claim may arriv e in a Ma ryland circuit court in four distinct ways. First, the claim may be fully arbitrated under the procedures of § 3-2A-05 and require nothing more fro m the cou rt than confirmation of th e aw ard. § 3-2A -05. Alte rnatively, under § 3-2A-06, the claim may proceed through the arbitration procedures of § 3-2A-05, the award may be rejected by one of the parties in accordance with § 3-2A-06(a), and the rejecting party may file an a ction in a circuit court to nullify the award an d proceed to trial. §§ 3-2A-06(a) and (b). The third and four th avenue s into court for a health care malpractice claim are through waiver of arbitration under §§ 3-2A-06A or 3-2A-06B, either mutually by both sides or unilaterally by the plaintiff or any defendant, respectively, and the filing of a claim in a circ uit court. -20- It is obvious that a claim following the first path, full arbitration under § 3-2A-05, will result in an award under § 3-2A-05 of this subtitle, and the cap on non-economic damages contained in § 3-2A -09 will apply. It is equally clear and undisputed that, where an arbitration award issues and a party rejects the award under § 3-2A-06(a), electing instead to proceed to trial on the claim, the resulting verdict constitutes a ve rdict under § 3-2A-06" and the cap is applicable. The question we must resolve in this case is whether the reference in § 3-2A-09(a) to a verdict under § 3-2A-06 of this subtitle enco mpasses r esultant verd icts reached via the other two aven ues f or re solu tion of health care malp racti ce cl aims , nam ely, those resulting from cases that arrive in court following either mutual or unilateral waiver of arbitratio n under § § 3-2 A-0 6A o r 3-2 A-0 6B, r espe ctive ly. Sections 3-2A -06A and 3-2A -06B address solely the procedures for waiving arbitration in health care malpractice claims. Due to their limited scope in outlining the procedures for waiving arbitration, the sections make no mention of verdicts, nor do they address court procedures following wa iver of arbitration. Both sections, how ever, provide explicitly that, [i]n any case subject to this section, the procedures of § 3-2A-0 6(f) of this subtitle shall apply. §§ 3-2A-06A(e) and 3-2A-06B(h). Thus, where a case has been waived properly out of arbitration under §§ 3-2A-06A or 3-2A-06 B and p roceeds to tria l in a circuit court, the claim is subject to the procedures of § 3-2A-06(f), which provides for itemization of the jury s verdict into specific categories, the filing of an objection to the jury s verdict base d on its excessive nature, and the court s consideration and resolution of -21- any objection. § 3-2A-06 (f). It is clear that, if a verdict is returned under the procedures of § 3-2A-06(f), it constitutes a verdict under § 3-2A -06 of this sub title. Despite the Circuit Court s reasoning and the Semskers argument that the verdict obtained in the present case was a verdict under § 3-2A-06B, there can be no such verdict; where arbitration is waived, according to the specific command s of §§ 3-2A-0 6A(e) and 3-2A -06B(h), the only verdict in a health care malpractice case is one obtained in accordance with the procedures of § 3-2A-06(f) and, thus, a verdict under § 3-2A-06 of this subtitle. Regardless of whether the verdict comes after rejection of an arbitration award or waiver of arbitration, it is a verdict under § 3-2A-06 of this subtitle and is subject to the cap provided for in § 3-2A-09. Our conclusion that the reference in § 3-2A-09(a) to a verdict under 3-2A-06 includes verdicts in cases where arbitration is waived in accordance with §§ 3-2A-06A or 32A-06B is reinforced by the language of the subsection that follows, § 3-2A-09(b). That subsection states that an award or verdict under this subtitle for non-economic damages for a cause of action arising between January 1, 2005, and December 31, 2008, inclusive, may not excee d $650 ,000. § 3-2A-09(b). By reference to the entirety of subtitle 3-2A, subsection (b) contemplates a cap o n all non-econom ic damage aw ards and verdicts in health ca re malpractice cases, including those brought under §§ 3-2A-05, -06, -06A, and -06B, regardless of their derivation. Thus, the language of subsection (b) supports our conclusion that the cap on non-ec onomic dam ages applies to claims for w hich arbitration is waived -22- under §§ 3-2A-06A or 3-2A-06B. We hold that, based on the plain meaning of § 3-2A-0 9 and the s pecific provisions of §§ 3-2A-06A and 3-2A-06B referring to the procedures of § 3-2A-06(f) regarding the issuance of verdicts, the cap on non-e conomic damages contained in § 3-2A-09(b) applies to all health care malpractice claims, whether they are: (1) arbitrated under § 3-2A-05; (2) arbitrated, but followed by a rejection of the arbitration award under § 3-2A-06; or (3) waived out of arbitration under §§ 3-2A-06A or 3-2A-06B. Thus, the cap on non-e conomic damages was applicable to the Semskers claims in the present case. C. The Legislative History of § 3-2A-09(a) For the sake of completeness, we may resort to legislative history to ensure that our plain language interpretation is correct. Zimmer-Rubert, 409 Md. at 214, 973 A.2d at 241; see also Shenker v. Laureate Educ., Inc., __ Md. __, __ A .2d __ (2009) (reviewing legislative history for the sake of testing the validity of our construction in the context of statutory interpretation). The language of § 3-2A -09(a) at issue in this case was enacted by the General Assembly during an emergency special session called by then Governor Robert Ehrlich on 28 December 2004. The bill that emerged from that intense special session, House Bill 2, included the current language of § 3-2A-09(a), stating that the non-economic damages cap applies to an award un der § 3-2A-05 of this subtitle or a verdict under § 3-2A-06 of this subtitle. The initial pertinent language of the bill, as it appeared during the first and second -23- readings in the House of Delegates, however, provided that the cap applies to a judgment under this subtitle. The Circ uit Court, in its analysis, focused on the change in this wording and concluded that the amendment to § 3-2A-09 in the enacted version of House Bill 2 had the effect of n arrowing the ambit o f the statute from general application to all medical malpractice actions to application to only certain medical malpractice actions. Thus, the trial court appa rently believed th e Genera l Assemb ly had delibera tely and specific ally amended § 3-2A-09(a) to exclude application of the cap to cases for which arbitration had been waived under §§ 3-2A-06A or 3-2A-06B. There exists, however, a considerably more reasonable interpretation of the purpose behind the General Assembly s change in language from the initial formulation of § 3-2A09(a) in House Bill 2 and its final enacted version clarity. Originally, § 3-2A-09(a ) purported ly applied the cap on non-economic damages to judgments. Statutorily-mandated caps, however, should be applied to reduce verdicts, which are issued by juries, rather than judgm ents, which are entered by judges. A jury may not be informed of the statutory cap on dama ges, see § 3-2A-09(c)(1), and, thus, its verdict may exceed the cap and require reduction. Judges, however, are presumed to know the law and do not enter judg ments in excess of the statutory caps. As such, the General Assembly altered the language of § 32A-09(a) to apply to an award or a verdict, rather than to judgments, in order to reflect the distinction between the conce pts and clarif y that the cap on non-eco nomic da mages is applied to the arbitration award or the jury s verdict, not the judicially-entered final -24- judgme nt in the case. The Circuit C ourt s belief that the change re presented a deliberate decision to remove from the ambit of the cap claims for which arbitration was waived under §§ 3-2A-06A or 3-2A-06B, without any legislative history to suggest that the General Assembly intended such a sea change, requires a considerable leap in reasoning. In addition, during the special session, the General Assembly added subsection (e) to § 11-108, the general cap on non-eco nomic damages for personal injury actions. 2004 Md. Laws (Spec. Sess.), ch. 5, at 57. Subsection (e) states that [t]he provisions of this section do not app ly to a verdict und er Title 3, Sub title 2A of th is article for da mages in which the cause of action arises on or after January 1, 2005. § 11-108(e). The amendment removed health care malpractice actions from the ambit of the general non-economic damages cap of § 11-108. If the Circuit Court s interpretation of § 3-2A -09(a) we re adopted , no cap w ould apply to health care malpractice claims for which arbitration is waived under §§ 3-2A-06A or 3-2A-06B, due to the operation of § 11-108(e). Such cases would represent the only personal injury claims singled out for exemption from a cap on non-economic damag es. Without any legislative history supporting this interpretation, it would be unreas onable to conclude that the General Assembly, when it clarified the language of § 3-2A-09(a), intended such a resu lt. As such, the legislative history, although not conclusive, supports our holding that the non-eco nomic damage s cap con tained in § 3 -2A-09 a pplies to all health care malpractice claims, including those for which arbitration has been waived under §§ 3-2A-06A or 3-2A- -25- 06B. The C ircuit Court s holding to the con trary was error. IV. The Order of Ope ration of th e Cap a nd Settlem ent Cre dit Out of an abundance of caution, the Circuit C ourt assum ed hypothetic ally that the cap might be applicable to the present case and determined that any pro rata reduction of the verdict, based on Dr. Marcus s joint tortfeasor settlement with the Semskers, should be taken into account p rior to application of the non-economic damages cap.16 We reac h the oppo site conclusion, holding that the cap on non-economic damages must be applied to reduce the award o r verdict prior to any reduction based on a joint tortfeaso r settlement. The statute gove rning the ef fect of a joint tortfeasor settlement and release is § 31404, entitled Effect of release on injured person s claim. That section provides: A release by the injured person of one joint tort-feasor, whether before or after judgment, does not discharge th e other tortfeasors unless the re lease so pro vides, but it reduces the claim against the other tort-feasors in the amount of the consideration paid for the release or in any amount or proportion by which the release provides th at the total claim shall be redu ced, if greater than the consideration paid. § 3-1404. Thus, as noted by the Circuit Court, the statute defers to the language of th e release for th e effect of the settlemen t. 16 According to the Circuit Court s calculations, app lying the pro rata reductio n first, followed by the cap on non-economic damages, would result in a total judgment of $2,172,936 against the Physicians as non-settling tortfeasors. Reversing the order of operations and applying the cap prior to the pro rata reduction would result in a total judgment of $1,766,686 against the Physicians. Thus, the determination of the appropriate order of operation impacts the amount of the judgment against the Physicians by $406,250. -26- The release between the Semskers and Dr. Marcus ackn owledged Dr. Marcus position as a joint tortfeasor and called for a pro rata reduction of any verdict or judgment of any non-settling tortfeasor. The Circuit Court concluded that the word verdict in the release meant the verdict prior to theoretical application of the statutory cap, and that the word judgment referred to the capped verdict. Characterizing its conclusion as fairness in giving the Semskers the benefit of their bargain with D r. Marcus, the Circuit Co urt determined that the joint tortf easor settlem ent credit would apply to the uncapped verdic t, rather than the capped judgment. We disagree with the Court s conclusion in this regard and hold th at the word verdict in th e release m eans inhere ntly the capped verdict. Section 3-2A-09 (b) provide s that an aw ard or verd ict under this subtitle for nonecon omic damages for a cause of action arising between January 1, 2005, and December 31, 2008, i nclusiv e, may not exceed $ 650,000. § 3-2A-09(b) (emphasis added). The section mandates that a jury s verdict may not exceed the statutory cap. Thus, any verdict rendered by a jury exceeding the amount of the non-economic damages cap inherently is a verdict in the amount of the cap from the moment it is rendered. Under this construction, the reference in the release to a verdict cannot m ean the uncappe d jury s verdict which exceeds the statutorily-mand ated cap; § 3-2A-09 (b) states exp licitly that there can be no suc h verdict. As such, the v erdict or judg ment in th is case are on e in the same the amo unt of the jury s verdict reduced in conformity with the non-economic damages cap of § 3-2A-09 (b). Thus, the appropriate order of operations is to apply first the cap to the jury s verdict for non- -27- econom ic damag es, followe d by a credit fo r the joint tortfea sor settlemen t. In addition, the release states that [a]ll damages arising out of the occurrence recovera ble by the [Sem skers] again st anyone othe r than [D r. Marcus ] will be reduced as provided in [§ 3-1404]. (Emphasis added). Due to the application of the non-economic damages cap, the only non-economic damages recovera ble by the Semskers from the Physicians are the damages capped by § 3-2A-09(b). This portion of the release further suggests that any pro rata credit for the joint tortfeasor settlement with Dr. Marcus will be applied only after application of the non-economic damages cap. Had Dr. Marcus not settled with the Semskers, and had the Sems kers proce eded to trial against Dr. Marcus and Dr. Albert, the cap on non-economic damages would have been applied to the total verd ict, not to each def endant s p ro rata share o f the verdic t. Application of the pro rata c redit for Dr. Marcus settlement prior to application of the cap on noneconom ic damages would not yield a consistent outcome. Rather, such an order of operations hypothetically would enable the Semskers to recover total non-economic damages in an amount in excess of the cap, much the same as if the cap applied only to each defendant s pro rata share of non-economic damages, thus negating the purpose of the cap limiting recovery of n on-econ omic dam ages. In ord er to preserve the effectiveness of the cap on non-economic damages and ensure that the joint tortfeasor settlement does not affect Dr. Albert s potential liability for n on-econ omic damages, the cap must be applied prior to any pro rata cred it for a joint tortfe asor settleme nt. -28- The order of operation that we hold applicable today, applying first the cap on noneconom ic damages followed by any credit for a joint tortfeasor settlement, has been adhered to previo usly by M aryland c ourts w ithout ex ception . See Franklin v. Morrison, 350 Md. 144, 153, 174-75, 711 A.2d 177, 182, 192-93; Anne Arundel Med. Center, Inc. v. Condon, 102 Md. App . 408, 414, 649 A .2d 1189 (1994 ). V. Evid ence of W rite-Offs a nd the C ollateral So urce R ule The Circuit Court held that, bec ause the P hysicians failed to adduce at trial evidence of certain write-offs of past medical expenses by Mr. Semsker s health care providers, the Physicians could not a vail themse lves in a pos t-trial motion of the provisions of § 3-2A09(d)(1), which provides that [a] verdict for past medic al expense s shall be limite d to: (i) [t]he total amount of past medical expenses paid by or on behalf of the plaintiff; and (ii) [t]he total amount of past medical expenses incurred but not paid by or on behalf of the plaintiff for which the plaintiff or another person on behalf of the plaintiff is obligated to pay. § 32A-09(d)(1). The Physicians contend that presentation of such evidence during trial w ould have constituted colla teral source evidence contravening the dictates of the common law collateral source rule. That rule permits an injured person to recover the full amount of his or her provable damages, regardless of the amount of compensation which the person has received for his [or her] inju ries from so urces unre lated to the tortf easor, and generally prohibits presentation to a jury of evidence of the amount of medical expenses that have been or will be p aid by he alth insu rance. Haischer v. CSX Transportation, Inc., 381 Md. 119, -29- 132, 848 A.2d 620, 627 (2004) (quoting Motor Vehicle Admin. v. Seidel, 326 Md. 237, 253, 604 A.2d 472, 481 (1992)) . Rather, they maintain, reduction of a jury s verdict to reflect write-offs should be undertaken by the trial judge and occur during the post-verdict remittur phase. In its determination, the Circuit Court found that § 3-2A-09(d) clearly grafts a legislative exception to the collateral source rule because, unlike subsection (c)(1), which states that juries may not be informed of the non-economic damages cap and that verdicts for non-eco nomic damages in excess of the cap shall be reduc ed by the cou rt post-verdic t, subsection (d) contains no such limitations or instructions. We disagree w ith the trial court s conclusion and hold that evidence of write-offs by health care providers should be considered post-verdic t by the court, rathe r than prese nted to the ju ry during trial. The language of § 3-2A-09(d)(1) makes no mention of the collateral source rule, nor does it provide that evidence concerning the payment or write-off of past medical expenses must be su bmitted d uring tria l for consideratio n by th e jury. This Court long has recognized the principle of statutory interpretation that the common law will not be deemed as repealed by implication. Suter v. Stuckey, 402 Md. 21 1, 232, 935 A.2d 73 1, 743 (20 07); Robinson v. State, 353 M d. 683, 6 93, 728 A.2d 6 98, 702 (1999 ). Thus , if possible, we shall striv e to interpret § 3-2A-09(d) to avoid repeal or altering the application of the common law collateral source rule. Section 3-2A-09(d)(1) states that verdicts for past medical expenses shall be limited -30- to the total amount of past medical expenses paid by or on behalf of the plaintiff and the total amount of past medical expenses incurred, but not yet paid, for which the plaintiff or another person on behalf of the plaintiff is obligated to pay. § 3-2A-09(d)(1). Thus, the section mandates that amounts written-off shall not be included in the verdict. The question, for which the statute provides no express answer, is w hether con sideration of write-offs falls to the jury during trial or to the judge post-verdict in rem ittur. If it is for the jury to consider write-offs and reduce their verdict ac cordingly, it will be necessary for a defendant to introduce evidence to the jury of the actual payments made by the plaintiff s health insurers or other collateral sources. As noted supra, such evidence contravenes the collateral so urce doctr ine. Adopting this interpretation w ould require reading § 3-2A-09(d), as the Circuit Court did here, as fashioning a legislative exception on the collateral source rule, despite the statute s omission of any reference to that rule. Alte rnatively, if evidence of write-offs and disco unts by the plaintiff s health care providers is to be presen ted to the co urt in a post-v erdict remittur s etting, similar to the procedures found in §§ 3-2A-05(h) and 3-2A-09(c), the collateral source doctrine is not implicated or violated. Under this interpretation, the collateral source rule and § 3-2A-09 may be harmonized such that collateral source evidence of write-offs and disco unts is not presented to the jury, but to the court, after the jury has rendered its verdict. Compelled by our duties to harmonize statutory language wherever possible and avoid repeal of the common law by implication, we embrace the latter interpretation as most consistent with the legislative intent -31- and pri nciples of statu tory interp retation . As to the Circuit Court s contention regarding the omission from § 3-2A-09(d) of language similar to that in § 3-2A-09(c)(1) that juries not be info rmed of th e non-eco nomic damages cap, we note that the long-standing acceptance of the collateral sou rce rule and its prohibition on the presentation of collateral source evidence to the jury obviates any need for the General A ssembly to conf irm its ap plicabilit y in § 3-2A -09(d). Longstanding principles of the common law need no such statutory affirmation to have continuing effect. Thus, we hold that any evidence of w rite-offs and discounts by M r. Semsker s health care providers properly is con sidered po st-verdict by the c ourt, rather than at trial to the jury. The Circuit Court erred by finding that the Physicians waived their right to reductions under § 3-2A09(d) base d on their fa ilure to presen t evidence o f the write-o ffs during the trial. VI. Conclusions To summa rize, we ho ld that: (1) the non-economic damages cap provided for in § 32A-09(b) applies to all health care malpractice claims brought under subtitle 3-2A, including the present case for which arbitration had been waived pursuant to § 3-2A-06B; (2) the noneconom ic damages cap should be applied to the jury s verdict prior to application of the pro rata credit provided for in D r. Marcus s joint tortfeasor settlement and release; and, (3) the Physicians did not waive their right to any potential reduction under § 3-2A-09(d) based on write-offs by Mr. Sem sker s health care provid ers due to their failure to adduce at trial evidence of such write-offs. Our holdings rest squ arely on the principles of sound s tatutory -32- interpretation and track the General Assembly s intent for the con sideration of health care malpractice claims. We reverse the judgment of the Circuit Court for Montg omery Cou nty and remand the case to it with directions that the court apply, in accordance with § 3-2A09(b), the cap on non-eco nomic damage s to the verd ict, prior to app lication of the pro rata credit based on the Semske rs joint tortfeaso r settlement w ith Dr. M arcus, and to conduct a remittur hearing to determine the am ount of any write-offs by Sem sker s health care prov iders and redu ce th e jud gme nt ac cord ingly. JUDGMENT OF TH E CIRCU IT COURT FOR MONTGOMER Y C O U N T Y R E V E R S E D ; C A SE REMANDED TO THAT COURT FOR FURTHER PROCEEDINGS NOT IN C O N S I S T E N T W I T H T H IS OPINION; COSTS TO BE PAID BY THE APPE LLE ES/P ETITIONERS, THE SEMSK ERS. -33-

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