Fourth Circuit: Maryland’s Three-Year Limitations Period (Not the Malpractice Act) Governs Fraud/Conspiracy Claims Tied to Healthcare

I. Introduction

In Jon Brunenkant v. Suburban Hospital, Incorporated, the United States Court of Appeals for the Fourth Circuit addressed a recurring classification problem at the intersection of healthcare litigation and general tort/intentional tort doctrine: when a plaintiff pleads fraud-based claims arising from a medical encounter, does Maryland’s specialized medical-malpractice limitations statute apply, or does the general civil limitations period control?

The plaintiff, Jon Lodwick Brunenkant (pro se), sued Suburban Hospital, Inc. and Suburban Hospital Healthcare System, Inc. asserting Maryland state-law claims for fraudulent misrepresentation and conspiracy to commit fraud. He alleged that during an October 2015 emergency gallbladder surgery episode, the hospital and surgeon represented the surgeon as the hospital’s employee/agent, and later concealed contract terms showing the surgeon was an independent contractor and that the hospital disclaimed supervisory responsibility.

The district court dismissed under Federal Rule of Civil Procedure 12(b)(6), holding the claims time-barred by applying Maryland’s five-year limitations provision for certain healthcare malpractice actions, Md. Code Ann., Cts. & Jud. Proc. § 5-109. The central appellate issue was whether the district court used the wrong statute of limitations—§ 5-109 instead of the general three-year period in Md. Code Ann., Cts. & Jud. Proc. § 5-101.

II. Summary of the Opinion

The Fourth Circuit (Judge King, joined by Judges Agee and Heytens) vacated and remanded. The court held that the district court erred by applying § 5-109 to Brunenkant’s fraud and conspiracy claims. Under Maryland law, the Health Care Malpractice Claims Act and § 5-109 cover only “traditional malpractice claims” involving a breach of the professional standard of care in the rendering (or failure to render) professional services. Fraud and conspiracy claims—though connected factually to a medical episode—are “claims for injuries arising from other causes in connection with health care” and therefore fall under the general three-year limitations period in § 5-101.

Importantly, the panel did not decide whether Brunenkant’s claims are timely under § 5-101, emphasizing that the accrual and discovery issues should be addressed by the district court on remand in the first instance.

III. Analysis

A. Precedents Cited

1. Standards of review and pleading-stage limitations dismissals

  • Semenova v. Md. Transit Admin. — Cited for de novo review of Rule 12(b)(6) dismissals and for the key constraint that a court may dismiss on limitations grounds at the pleading stage “only if the time bar is apparent on the face of the complaint.” This principle mattered because the limitations question turned on which statute applied; if the wrong statute is chosen, “apparent” untimeliness is illusory.
  • Mylan Lab'ys., Inc. v. Matkari and Moretti v. Thorsdottir — Reinforced the standard Rule 12(b)(6) posture: accept factual allegations as true and draw reasonable inferences in the plaintiff’s favor. That framing supported the court’s refusal to collapse fraud into malpractice merely because the facts arose in a medical setting.
  • Short v. Hartman — Used to hold that Brunenkant forfeited appellate review of the denial of his Rule 59(e) motion by not briefing it. This narrowed the appeal to the statute-of-limitations ruling.

2. Erie methodology: predicting Maryland law

  • Tederick v. LoanCare, LLC and Zeigler v. Eastman Chem. Co. — The court characterized its task as an “Erie guess” because the Supreme Court of Maryland had not decided the precise limitations question for fraud/conspiracy claims tied to alleged malpractice. These cases supplied the predictive framework: federal courts must anticipate what the state high court would do.
  • Moshoures v. City of N. Myrtle Beach — Emphasized institutional humility: state courts have the final word on state law. The panel’s reasoning was presented as faithful prediction rather than authoritative pronouncement about Maryland law.

3. The scope of the Health Care Malpractice Claims Act and § 5-109

  • Cannon v. McKen — The foundational Maryland decision limiting the Act’s reach to claims involving a breach, “in [the defendant’s] professional capacity,” of the duty to exercise professional expertise or skill. Cannon also expressly distinguished non-professional torts (e.g., “premises liability, slander, assault”) from Act-covered malpractice. The Fourth Circuit treated Cannon as the controlling statement of scope.
  • Brooks v. Md. Gen. Hosp., Inc. — A Fourth Circuit application of Maryland law explaining that, despite broad statutory language, Maryland courts limit the Act to “traditional malpractice claims” and exclude “[c]laims for injuries arising from other causes in connection with health care.” The panel leaned heavily on Brooks to classify Brunenkant’s fraud and conspiracy allegations as excluded “other causes.”
  • Anderson v. United States — Cited for background and history of § 5-109, supporting the idea that the five-year statute functions within a specialized malpractice framework rather than as an all-purpose limitations rule for anything tangentially related to healthcare.

4. Fraud limitations and accrual principles under Maryland law

  • Phillips v. G.D. Searle & Co. and Bd. of Educ. of Charles Cnty. v. Plymouth Rubber Co. — Used to show that Maryland’s general three-year statute, § 5-101, is the typical limitations provision for fraudulent misrepresentation and civil conspiracy claims.
  • Poffenberger v. Risser — The canonical articulation of Maryland’s “discovery rule” for accrual: a cause of action accrues when the claimant knew or reasonably should have known of the wrong.
  • Hartnett v. Schering Corp. — Elaborated a two-part “should have known” inquiry: (i) knowledge of circumstances that would cause a reasonable person to investigate, and (ii) reasonable diligence would have led to knowledge of the tort.
  • O'Hara v. Kovens — Reinforced that diligence, concealment, and when discovery should have occurred are typically fact questions for a jury, underscoring why the Fourth Circuit declined to decide timeliness under § 5-101 on appeal.

5. Complaint framing and appellate restraint

  • Johnson v. Charlotte- Mecklenburg Schs. Bd. of Educ. — Cited for the proposition that the plaintiff is “master of [his] complaint,” supporting the court’s refusal to recharacterize pleaded fraud/conspiracy as malpractice merely to apply § 5-109.
  • United States v. Avilla — Invoked for the principle that appellate courts are “a court of review, not first view,” which justified leaving the § 5-101 accrual/timeliness analysis to the district court on remand.

B. Legal Reasoning

The court’s reasoning proceeds in three steps.

  1. Identify the doctrinal boundary of § 5-109. Drawing primarily from Cannon v. McKen (and consistent with Brooks v. Md. Gen. Hosp., Inc.), the panel treated the Maryland Act as limited to claims where the gravamen is professional negligence—i.e., breach of the professional standard of care in providing healthcare services. The opinion treats this limitation as a matter of claim type, not merely factual context.
  2. Classify Brunenkant’s pleaded claims as outside that boundary. Although the alleged misrepresentation and concealment occurred “in connection with health care,” they did not allege a breach of the professional duty to exercise medical expertise or skill. Instead, they alleged deception about employment/agency status and concealment of contractual disclaimers. Under Brooks v. Md. Gen. Hosp., Inc., such claims are excluded from the Act as “injuries arising from other causes.”
  3. Apply the default limitations regime and remand. Having determined § 5-109 is inapplicable, the panel pointed to § 5-101 and the discovery rule (Poffenberger v. Risser) as the governing framework. But it declined to decide accrual and timeliness, emphasizing that diligence and concealment issues are often fact-bound (O'Hara v. Kovens) and should be assessed by the district court in the first instance.

The net result is a clear holding on classification (fraud/conspiracy vs. malpractice for limitations purposes), coupled with deliberate restraint on application (when the three-year period began and whether tolling or concealment doctrines apply).

C. Impact

This published Fourth Circuit decision is likely to shape Maryland-related healthcare litigation in federal court (and potentially in state court as persuasive authority) in several ways:

  • Limits the reach of § 5-109 beyond negligence claims. Defendants cannot automatically invoke the malpractice statute of limitations for any claim factually connected to medical treatment. The focus is on whether the claim asserts a breach of professional skill/standard of care (Act-covered) or alleges a different species of wrong (not covered).
  • Encourages careful claim pleading and motion practice. Plaintiffs may plead fraud, concealment, or agency-misrepresentation theories to pursue remedies that do not depend on proving malpractice elements. Conversely, defendants may respond by contesting whether such claims are truly independent or are impermissible repackaging—though this opinion emphasizes that plaintiffs control their pleaded causes of action (Johnson v. Charlotte- Mecklenburg Schs. Bd. of Educ.).
  • Shifts timeliness disputes from categorical bars to fact-intensive accrual inquiries. By channeling fraud and conspiracy claims into § 5-101 and Maryland’s discovery rule, disputes may more often turn on what the plaintiff knew, when a reasonable investigation should have occurred, and whether concealment prevented discovery—issues often ill-suited to dismissal at the pleadings stage (Semenova v. Md. Transit Admin.; O'Hara v. Kovens).
  • Signals restraint on certification but clarifies Erie prediction. The panel declined certification because the parties opposed it and the court felt able to decide. Future litigants should nonetheless expect close attention to Maryland high-court signals (as here, via Cannon v. McKen and related precedent) when state law is unsettled.

IV. Complex Concepts Simplified

  • Statute of limitations: A filing deadline. If you sue after it expires, the claim can be dismissed as time-barred.
  • § 5-109 vs. § 5-101 (Maryland): § 5-109 is a specialized limitations statute for certain medical malpractice actions; § 5-101 is the general three-year deadline for most civil claims, including fraud, unless another statute specifically applies.
  • “Traditional malpractice” (as used in the opinion): Claims alleging that a healthcare provider failed to meet the professional standard of care in delivering medical services—i.e., negligence in medical judgment/skill.
  • Discovery rule: Under Poffenberger v. Risser, the limitations clock generally starts when the plaintiff knew or reasonably should have known of the wrong—not necessarily when the event occurred.
  • Rule 12(b)(6): A motion to dismiss for failure to state a claim. Courts generally can dismiss on limitations grounds only when untimeliness is clear from the complaint itself (Semenova v. Md. Transit Admin.).
  • Erie guess: When state law is unsettled, a federal court applying state law in diversity predicts how the state’s highest court would rule (Tederick v. LoanCare, LLC; Zeigler v. Eastman Chem. Co.).

V. Conclusion

The Fourth Circuit’s decision establishes a practical and clarifying rule for Maryland-related healthcare disputes: fraud and conspiracy claims connected to medical treatment do not automatically become “medical malpractice” for limitations purposes. Consistent with Cannon v. McKen and Brooks v. Md. Gen. Hosp., Inc., Maryland’s malpractice limitations statute, § 5-109, is confined to claims alleging a breach of professional skill or standard of care, while fraud-based claims are governed by the general three-year statute, § 5-101, with accrual governed by the discovery rule.

By vacating the dismissal and remanding without deciding timeliness under § 5-101, the court also reinforces an important procedural lesson: when limitations depend on claim classification and fact-bound accrual questions, premature dismissal at the pleading stage is disfavored unless the bar is truly apparent on the complaint’s face.