INTRODUCTION
Thе question presented here is whether a claim against a doctor that arises out of unauthorized and duplicative billing practices falls within the range of actions subjected to the two-year statute of limitations applicable to certain actions brought against health care providers. See 516.105, RSMo Supp.2008. 1 Plaintiffs in this case appeal the circuit court’s judgment of dismissal based on the two-year filing timeframe. This court finds that the Plaintiffs’ claims are not subject to section 516.105 and reverses the circuit court’s dismissal.
Factual Background
On March 9, 2006, Plaintiff Ron Merchant, through his daughter and attorney in fact, Sue Berry, brought this suit against Dr. Hueser and others practicing under the name “Boone Clinic” in Columbia, Missouri. Along with Merchant, the petition claimed to represent as plaintiffs “all other similarly situated consumers” of Dr. Hueser’s medical practice. 2 In an amended petition, Plaintiffs added Greg Katzing as a named plaintiff. The trial court later ordered the substitution of Daniel Breeden, personal representative of the estate of the deceased Ron Merchant, in the place of “Ron Merchant by and through Sue Berry” as a plaintiff.
According to the amended petition, 3 Merchant’s wife received chemotherapy treatments from Dr. Hueser, the last of which was administered in September of 2001. Katzing was also one of Hueser’s chemotherapy patients. He was last treated in 1997. The petition alleges that Dr. Hueser devised and executed a scheme to defraud his patients by treаting multiple patients with doses of chemicals pulled from a single vial, where common medical practice and government regulations dictated that a new vial was to be used for each treatment. The scheme involved charging each patient the full price of a new vial for each treatment but sometimes providing them with the left-over chemicals from another patient’s treatment. As this type of impropriety is difficult to detect, especially since the typical lay person has little to no knowledge of the rules and standards relating to the handling and administration of pharmaceuticals, Plaintiffs were not aware of the scheme until after the treatment had ended.
In Novembеr of 2005, Merchant and Katzing learned that Dr. Hueser had paid a settlement to the federal government for improperly billing Medicare multiple times for single-use chemotherapy vials. The petition claims it was not until that time that either Merchant or Katzing knew they had been improperly billed for the chemicals provided by Dr. Hueser. The amended petition names Dr. Hueser and twenty- *6 two other doctors as defendants, as well as Medical Network Technologies, L.L.C. These other doctors are alleged to have carried on a de-facto partnership with Dr. Hueser by conducting business with him under the name “Boone Clinic.” Boone Clinic is apparently not a registered business entity of any kind and is alleged to be an unofficial arm of Medical Network Technologies, L.L.C. Plaintiffs seek to hold all of the doctors vicariously liable for the acts of their partner, Dr. Hueser.
The amended petition claimed (1) that Dr. Hueser’s actions created liability under chapter 407, the Merchandising Practices Act 4 (MPA); (2) that fraud was committed through implied representations that the drug being purchased and administered was compliant with certain requirements; and (3) that the twenty-three doctors making up the Boone Clinic joined in a civil conspiracy to defraud patients by re-using single-use vials of medication. 5 Several motions to dismiss were filed by various defendants, the most prominent argument being that the claims set forth in the amended petitiоn should fall under the scope of section 516.105 and be barred by its two-year limitation on healthcare malpractice actions. The circuit court granted a dismissal based on the statute, stating “the court finds that the action alleged is one of malpractice related to health care for which damages are sought against alleged health care providers and that the period of limitations applicable is two years from the date of occurrence of the act complained of as specified in [section] 516.105.” The trial court found that the action was not commenced within two years of the most recent treatment of either Mrs. Merchant or Mr. Katzing. Plaintiffs’ primary argument on appeal is that the trial court improperly branded the action as one for medical malpractice or negligence and applied the wrong statute of limitations.
STANDARD OP REVIEW
In reviewing a trial court’s grant of a motion to dismiss, this court gives the pleadings their broadest intendment, treats all alleged facts as true, and construes the allegations favorably to the plaintiff.
Arbuthnot v. DePaul Health Ctr.,
1. Statute of Limitations Question
Section 516.105 states, “All actions against physicians, hospitals ... [or] any other entity providing health care services ... for damages for malpractice, negligence, error or mistake related to health care shall be brought within two years from the date of occurrence of the act of neglect complained of.... ” § 516.105, RSMo. The section’s opening phrase “all actions against physicians” is qualified by the words “for damages for malprаctice, negligence, error or mistake related to health care.”
Rowland v. Skaggs Co., Inc.,
Missouri courts look tо the gist or gravamen of an action to decide whether it should be governed by the two-year statute of limitations.
See, e.g., Nat’l Credit Assocs., Inc. v. Tinker,
This court, in
State ex rel. Sperandio v. Clymer,
examined a fraud claim against a physician with respect to the applicability of the medical malpractice statute of limitations.
See
The
Sperandio
holding recognizes that bona fide fraud claims against physicians are outside the scope of the two-year medical malpractice limitation.
See Sperandio,
Furthermore, the nature of Defendants’ actions do not fit under the categories of “malpractice, negligence, error or mistake,” the types of actions to which the two-year statute’s applicability is limited. The Plaintiffs’ petition clearly asserts intentional acts by Defendant Hueser. Executing a scheme such as has been alleged cannot be categorized as negligence, error, or mistake. The remaining question then, is whether it would fit under the “malpractice” designation. For purposes of applying the two-year statute of limitations, Missouri courts have defined “malpractice” as the “improper performance by a physician or surgeon of the duties devolved and incumbent upon him and the services undertaken by him ...
whereby the patient is injured in body and health.” Spruill v. Barnes Hosp.,
2. Federal Preemption
After Plaintiffs filed their original and amended petitions, Defendants removed the case to the U.S. District Court for the Western District of Missouri. As the basis for their argument that a federal question was raised, Defendants asserted that Plaintiffs’ claims relied on federal statutes, specifically those encoded in the Food, Drug and Cosmetic Act (21 U.S.C. § 301
et seq.).
The federal district court granted Plaintiffs’ motion to remand, explaining that “unless the FDCA component of the case is determinative of the outcome ... mere reference to [the] FDCA and its regulations as an element of the state claim does not provide a basis for federal question jurisdiction.”
Merchant v. Hueser,
No. 06^079-CV-C-NKL,
Although the federal district court already addressed the issue of preemption of Plaintiffs’ claims by the FDCA in its remand to state court, this dоes not prevent a state court from thereafter dismissing the case based on its own determination that the claims are preempted.
See Kircher v. Putnam Funds Trust,
Defendants stress that the FDCA provides no private right of action (see 21 U.S.C. § 337;
Ethex Corp. v. First Horizon Pharm. Corp.,
Defendants’ reliance on
Anthony v. Country Life Manufacturing
to support their preemption argument is misplaced. In that case, the plaintiff brought an action under the Illinois Consumer Fraud and Deceptive Business Practices Act, essentially claiming a violation of that Act based on non-compliance with the FDCA.
See Anthony v. Country Life Mfg.,
No. 02C 1601,
3. Existence of a PARTNERSHIP
Certain defendants argued in their motion to dismiss that Plaintiffs failed to properly plead the existence of a partnership, joint venture, or agency relationship in the petition and, for this reason, the only party against whom the petition could have stated a claim upon which relief could be granted was Dr. Hueser. The motion suggested that claims against the other defendants should be dismissed. Because Plaintiffs seek to hold the other defendants vicariously liable for the acts of Dr. Hueser, those defendants argue that Plaintiffs’ failure to specifically plead facts which, if proved, would be lеgally sufficient to establish the existence of a partnership, joint venture, or agency relationship is fatal to Plaintiffs’ claim against them.
Plaintiffs respond that, by not filing a motion for a more definite statement, Defendants have waived the issue of the sufficiency of the petition with respect to allegations of partnership. While a motion for a more definite statement is one manner in which a defendant may complain about the sufficiency of pleadings, a motion to dismiss can also be used to raise the issue and Defendants here did not waive sufficiency by choosing to raise it in their grounds for dismissal.
See Sirna v. APC Bldg. Corp.,
The petition states that Dr. Hueser was “in partnership with the other physician defendants [in the Boone Clinic],” that the Boone Clinic “consisted] of a de facto partnership of physicians and / or physicians’ professional corporations,” and that such partners in the Boone Clinic were “acting in concert with James N. Hueser to do business and make a profit ... were joint venturers ... and had held themselves out as the partners of James Hues-er.” With respect to each of the physician-defendants, the petition alleged “they were operating together as joint venturers pooling the profits and sharing the expenses of the operation of the Boone Clinic.” It further states that the physicians of Boone Clinic were together engaged in the practice of medicine with the aim of making a profit. Most specifically, the petition sets out that “[o]n information and belief the business operated as a partnership with physicians responsible for splitting their share of the expenses and with partners receiving compensation based on the overall performance of the group practice.”
Defendants claim that a plaintiff must allege a “definite and specific agreement” whereby the alleged partners agreed to place their “money, effects, labor and skill, or some or all of them, in lawful commerce or business and to divide the profits and bear the loss in certain proportions” (quoting
Brotherton v. Kissinger,
Looking at the facts pleaded in the light most favorable to the Plaintiffs and taking reasonable inferences in their favor, the petition sufficiently pleads the existence of a partnership. The petition essentially sets forth that a group of professionals came together to operate the Boone Clinic as a business for profit, that they used their labor and skill as physicians to produce such profits, that they shared the profits made by the operation as a whole, and that expenses (or losses) were to be borne by the group collectively. From these allegations, a “definite and specific agreement” to operate the Boone Clinic as a medical partnership can be inferred. As Plaintiffs sufficiently pled the existence of a partnership, and thus correctly pled at least one ground upon which Dr. Hueser’s co-defendants could be held vicariously liable for his actions, this point is denied.
4. Abatement op Ron MeRChant’s Claims
The petition focuses on injury to the economic interests of Greg Katzing and Rоn Merchant as named plaintiffs representing a class of similarly situated persons. Defendants argue now, as they did previously in support of their motion to dismiss, that any claims Ron Merchant may have had against them abated upon his death and, consequently, that Daniel Breeden, the personal representative of Merchant’s estate, is not a proper party in this action.
At common law, actions based in tort abated at the death of either the person wronged or the wrongdoer.
State ex rel. Nat’l Refining Co. v. Seehorn,
At common law survivable actions are those in which the wrong complained of affects primarily property and property rights, аnd in which any injury to the person is incidental, while non-survivable actions are those in which the injury complained of is to the person and any effect on property or property rights is incidental. The reason for the common law rule was that the need to redress purely personal wrongs ceases to exist either when the person injured cannot be benefited by a recovery or when the person inflicting the injury cannot be punished, while, since the property or estate of the injured person passes to his or her personal representatives, a cause of action for injury done to the property or estate can achieve its purpose as well after the death of the owner as before.
1 Am.Jur.2d
Abatement, Survival, and Revival
§ 51 (2005). In Missouri, the common law rule of abatement prevails for tort actions except to the extent that it has been altered by statute.
Seehorn,
Defendants cite two cases for the proposition that an action based on monetary
*12
loss due to payment for medical services does not survive the death of the person making such a claim.
See Seehorn,
It is argued that even if the husband’s cause of action does not survive to his administrator as to loss of comfort, society and services of his wife, it doеs as to expenses incurred by him in her behalf on account of her injuries. Those expenses were incident to the wife’s injuries and occasioned thereby. They constituted an element, but only an element and not the main element, of the husband’s cause of action. From the injury to the wife two causes of action arose,one to the wife for her personal injury and one to the husband for damages to him because of loss of her comfort, society and services and which included also the right to reimbursement for expenses necessarily incurred by him in attempting to cure the wife. But we think the husband had but one cause of action though several different elements might be taken into account in determining the amount of his damage. All the elements of his damage resulted, as to him, incidentally or consequentially because of the injury to his wife. If the injury to his wife, depriving him of-inter alia-her services, something of pecuniary value, was not a wrong done to his property right ... it is difficult to see how the medical and surgical expenses consequentially caused to him by her injury could be treated as of themselves constituting a wrong done to his property rights.... So to hold would be to hold, in effect, that two causes of action accrued to the husband,-one for damage for the loss of comfort, society and services of the wife, which would not survive, and one for expenses incurred in her behalf, which would survive. We do not bеlieve the husband’s cause of action is thus separable for the purpose of survival.
Id. at 423 (internal citations omitted). The case at bar is distinguishable from Seehom in that Merchant’s claims were not deiived from or ancillary to an action for comfort, society, and services, leaving no need, in Merchant’s case, to sever an arguably property-based claim from one which is inherently personal. Merchant’s claims have not abated simply because they can be categorized as actions based on monetary loss due to payment for medical services
With regard to Merchant’s claim for fraud,
Foster v. Hesse
discusses the abatement of a fraud claim and is instructive.
*13
See
Merchant’s fraud claim is similar to the claim of the plaintiff in Foster in that both involved a loss of money due to the fraudulent actions of the defendants. Clearly, in Foster, the court found that such a claim involved wrongs done to interests in property. For this reason, Merchant’s fraud claim survives his death.
On the same basis, Merchant’s claim for civil conspiracy also survives. A claim for civil conspiracy sounds in tort and allows a plaintiff to hold multiple conspirators liable for his damages.
State ex rel. Willman v. Marsh,
As to Merchant’s MPA claim, there is no Missouri statute that specifically exempts actions under the MPA from abatement. Defendants urge this court to follow two opinions of the Texas Court of Appeals, San Antonio, which found that claims under Tеxas’ Deceptive Trade Practices Act (DTPA) abate on the death of the consumer.
See Mendoza v. American Nat’l Ins. Co.,
5. Addition of Katzing as a Plaintiff
Another ground stated by Defendants for dismissal is that Plaintiff Katzing is an improper party because leave was not granted by the circuit court fоr his addition as a plaintiff. Katzing was added to the suit by Plaintiffs’ first amended petition. Defendants argue that Rule 52.06 requires leave to be granted before a party can be added and that, in the absence of such leave, the claims of the improperly added party must be dismissed.
While Rule 52.06 allows joinder of parties at “any stage of the action” pursuant to court order, Rule 55.33(a) allows a pleading to be amended once as a matter of course “at any time before a responsive pleading is served” and does not require leave of court to add a new party.
See
Rule 55.33(a);
Moss v. Home Depot USA, Inc.,
6. DISCHARGE OF OBLIGATION TO PAY
Defendants’ remaining ground for dismissal is that Plaintiff Katzing lacks *15 standing to bring his claim due to the fact that he filed bankruptcy in October of 2005. According to Defendants, Katzing’s claims became a part of the bankruptcy estate upon the filing of the Chapter 7 bankruptcy petition and no efforts were made by Katzing to schedule the claim as exempt from the bankruptcy estate. This, they argue, means that thе right to bring suit belongs to the trustee in bankruptcy and not to Katzing, making him an improper party.
Defendants’ arguments here are not of the type properly considered in granting a motion to dismiss. Since they depend on the existence and timing of a bankruptcy petition and whether or not certain claims were exempt from a bankruptcy proceeding, certain facts would have to be established before the circuit court could make a determination. Evidence outside the pleadings cannot serve as the basis of granting a motion to dismiss.
Weems v. Montgomery,
Conclusion
The dismissal of this case by the circuit court is reversed and the case is remanded for further proceedings.
All Concur.
Notes
.In pertinent part, section 516.105 states,
All actions against physicians, hospitals, dentists, registered or licensed practical nurses, optometrists, podiatrists, pharmacists, chiropractors, professional physical therapists, and any other entity providing health care services and all employees of any of the foregoing acting in the course and scope of their employment, for damages for malpractice, negligence, error or mistake related to health care shall be brought within two years from the date of occurrence of the act of negleсt complained of....
. The amended petition seeks certification of the claim as a class action.
. Since this case was dismissed on the pleadings, the facts averred by the petition are treated as true for purposes of reviewing the judgment.
Arbuthnot v. DePaul Health Ctr.,
. The MPA is designed to “ 'preserve fundamental honesty, fair play and right dealings in public transactions.' ”
Schuchmann v. Air Servs. Heating & Air Conditioning, Inc.,
. Also included in the amended petition were claims of unjust enrichment and breach of an implied contract. Plaintiffs, however, expressly abаndoned these claims in their appellate brief.
. The courts have also rejected attempts to plead around the two-year statute by denominating a claim that is essentially for malpractice as one for general negligence.
See Robinson v. Health Midwest Development Group,
.
Pheanis
dealt with an action for rescission that did not include a claim for damages.
Pheanis,
