Lead Opinion
The questions presented in this case have been certified by the United States District Court for the District of Maryland, pursuant to the Uniform Certification of Questions of Law Act, Maryland Code (1974, 1984 Repl.Vol.), §§ 12-601 through 12-609 of the Courts and Judicial Proceedings Article. The questions involve Maryland’s statute of limitations for medical malpractice claims, codified as Maryland Code (1974, 1984 Repl. Vol.), § 5-109 of the Courts Article. That statute, which was enacted by ch. 545 of the Acts of 1975, effective July 1, 1975, provides in pertinent part as follows:
“An action for damages for an injury arising out of the rendering of or failure to render professional services by a health care provider, as defined in § 3-2A-01 of this article shall be filed (1) within five years of the time the injury was committed or (2) within three years of the date when the injury was discovered, whichever is the shorter."
I. Where there is a continuous course of medical treatment for a single medical condition, where such treatment begins before July 1, 1975, and concludes after July 1, 1975, is § 5-109 the applicable statute of limitations?
II. If § 5-109 is the applicable statute of limitations under such circumstances, when does the five (5) year portion of that statute begin to run, and when does the three (3) year portion of that statute begin to run?
III. Is § 5-109 unconstitutional as being in violation of Article 19 of the Maryland Declaration of Rights?
I.
The “Statement of Facts” contained in the Order of Certification reveals that William L. Hill filed a complaint in the federal district court on December 2, 1983, alleging medical malpractice by Joseph C. Fitzgerald, M.D., now deceased. Hill consulted Dr. Fitzgerald on referral from another physician for diagnosis and treatment of a urinary tract infection and was seen for the first time on January 27, 1975. He consulted Fitzgerald thereafter on a number of occasions and treatment ended on November 5, 1975. Specifically, Hill alleges that Dr. Fitzgerald was negligent in diagnosing his ailment to be multiple sclerosis when, in fact, he was suffering from a spinal tumor.
Hill contends that the incorrect diagnosis of multiple sclerosis was made as early as his first visit on January 27, 1975 and certainly not later than February 14, 1975. It is furthermore alleged that the incorrect diagnosis was adhered to throughout the subsequent course of Hill’s treatment, including his last visit to Dr. Fitzgerald on November 5, 1975. Eventually, Hill’s condition deteriorated to the extent that he sought other medical care, at which time a surgical procedure revealed that he had a spinal tumor and not multiple sclerosis.
Hill maintains that since the alleged misdiagnosis occurred prior to July 1, 1975, § 5-109 is not applicable in this case. He asserts that § 5-101 of the Courts Article is the statute of limitation which was applicable to malpractice claims prior to the enactment on July 1, 1975 of § 5-109. Under § 5-101 a lawsuit must be filed within three years from the date of accrual of the cause of action.
The parties acknowledge that Maryland recognizes the “discovery rule” whereby a cause of action accrues at the time the claimant first knew or reasonably should have known of the alleged wrong. See Poffenberger v. Risser,
II.
The first certified question seeks a determination of whether § 5-109 is applicable under the certified facts of this case. As earlier noted, § 2 of ch. 545 of the 1975 Act provides that the statute “shall apply only to injuries occurring after July 1, 1975.” (Emphasis supplied.)
We considered the meaning of the term “injury,” within the context of medical malpractice, in Oxtoby v. McGowan,
“shall take effect July 1, 1976, and shall apply only to medical injuries occurring on and after that date.”
The defendant in Oxtoby undertook to perform a hysterectomy and a bilateral salpingo oophorectomy (the removal of both fallopian tubes and ovaries) in order to prevent the development of ovarian cancer. However, he allegedly failed to remove part of one ovary and tube. As an alleged result, the patient died of cancer and the family brought a wrongful death action in the circuit court against the surgeon. Following a defendant’s verdict, the plaintiff claimed on appeal that the trial court was without jurisdiction because the case had not previously been submitted to an arbitration panel as required by the HCMCA. The plaintiff. argued that the HCMCA was applicable because, while the negligent act had occurred prior to the July 1, 1976 effec
In concluding that the HCMCA was inapplicable because the “injury” had occurred prior to its effective date, we noted:
“The General Assembly obviously was not concerned with invasions of a legally protected interest which do not cause harm in the sense of ‘loss or detriment in fact____’ Restatement (Second) Torts, § 7(2) (defining ‘harm’). The Act is concerned with the invasion of legally protected interests coupled with harm.”294 Md. at 93-94 ,447 A.2d 860 .
We then quoted as follows from State ex rel. McManus v. Board of Trustees of Policemen’s Pension Fund,
“The word ‘injury,’ in ordinary modern usage, is one of very broad designation. In the strict sense of the law, especially the common law, its meaning corresponded with its etymology. It meant a wrongful invasion of legal rights and was not concerned with the hurt or damage resulting from such invasion. It is thus used in the familiar law phrase damnum absque injuria. In common parlance, however, it is used broadly enough to cover both the damnum and the injuria of the common law, and indeed is more commonly used to express the idea belonging to the former word, namely, the effect on the recipient in the way of hurt or damage, and we cannot doubt that at this day its common and approved usage extends to and includes any hurtful or damaging effect which may be suffered by any one.”
We went on to say:
“Thus, in general, ‘medical injuries’ as used in the effective date clause refers to legally cognizable wrongs*696 or damage arising or resulting from the rendering or failure to render health care.”294 Md. at 94 .
We thus held in Oxtoby that the surgeon’s negligent act, coupled with the harm which resulted from leaving part of a fallopian tube and ovary in the patient, amounted to a legally cognizable wrong and hence a medical injury which occurred prior to July 1, 1976, rendering the HCMCA inapplicable. While most of the harm resulting from the negligent act in Oxtoby occurred after the HCMCA’s effective date, we indicated that all that is required is that the negligent act be coupled with some harm in order for a legally cognizable wrong — and, therefore, injury — to have occurred.
Indeed, in Oxtoby, we noted our agreement with an earlier decision of the Court of Special Appeals in Johns Hopkins Hospital v. Lehninger,
While § 5 of ch. 235 of the Acts of 1976 (the HCMCA effective date provision) speaks of “medical injury,” whereas § 2 of ch. 545 of the Acts of 1975 (§ 5-109’s effective
Whether the original allegedly negligent misdiagnosis of Hill’s condition caused some harm and therefore “injury” prior to July 1, 1975 is a question of fact to be determined in light of the principles articulated in Oxtoby. If the misdiagnosis did, the limitations provisions of § 5-109 would not be applicable. The pre-July 1, 1975 statute, § 5-101, would be applicable and the discovery rule as thereunder applied would ultimately control whether Hill’s injury claim was barred by limitations. On the other hand, if no harm, i.e., loss or detriment in fact occurred until after July 1, 1975, § 5-109 would apply and the provisions of that statute would govern Hill’s claim.
In so concluding, we have considered Fitzgerald’s contention that even if the original misdiagnosis and ensuing harm occurred prior to July 1, 1975, the common law “continuous course of treatment” rule, applicable in medical malpractice cases, operated to delay the accrual date of Hill’s cause of action until after the effective date of § 5-109. Therefore, according to Fitzgerald, no “injury” occurred under the continuing treatment rule until he finally discharged Hill from his care without having made a correct diagnosis. Fitzgerald’s position is that as Hill’s treatment was concluded in November of 1975, § 5-109’s five-year maximum limitation period would be applicable and would operate as a time bar to Hill’s claim.
Under the continuous course of treatment rule, as articulated in Waldman v. Rohrbaugh, supra,
*698 “if the treatment by the doctor is a continuing course and the patient’s disease or condition is of such a nature as to impose on the doctor a duty of continuing treatment and care, the statute does not commence running until treatment by the medical man for the particular disease or condition involved has terminated, unless during the course of treatment the patient learns or should reasonably have learned of the harm, in which case the statute runs from the time of knowledge, actual or constructive.”
Later in the course of its opinion, the Court restated the rule in these terms (
“[I]f the facts show continuing medical or surgical treatment for a particular illness or condition in the course of which there is malpractice producing or aggravating harm, the cause of action of the patient accrues at the end of the treatment for that particular illness, injury or condition, unless the patient sooner knew or reasonably should have known of the injury or harm, in which case the statute would start to run with actual or constructive knowledge.”
The continuing treatment rule has been applied in medical malpractice cases because of the confidential, special relationship that exists between patient and physician. Triangle Underwriters, Inc. v. Honeywell, Inc.,
Where applicable, the continuing treatment rule simply tolls the statute of limitations by delaying the accrual date of undiscoverable medical malpractice until the termination of treatment. The rule does not, however, govern the date upon which the actionable negligence occurred. Section 5-109 does not apply in any case unless the
Ill
The second certified question assumes the applicability of § 5-109 and seeks a determination as to when the three- and five-year limitation periods begin to run in a case which involves, as here, a continuous course of treatment for a single medical condition.
Section 5-109 provides that an action for medical malpractice “shall be filed ... within three years of the date when the injury was discovered” but in no event later than “five years of the time the injury was committed.” In determining the meaning of these words, we bear in mind that the language of the statute is the primary source from which the intent of the General Assembly is determined. See McAlear v. Me Alear,
While we recognize the rule that statutes are not to be construed to alter the common law by implication, see Hardy v. State,
IV
The third certified question assumes the applicability of § 5-109 and seeks a determination as to whether the
“That every man, for any injury done to him in his person or property, ought to have remedy by the course of the Law of the land, and ought to have justice and right, freely without sale, fully without any denial, and speedily without delay, according to the Law of the land.”
It is argued that access to courts is a fundamental right which is abrogated by § 5-109 for those plaintiffs who do not discover injuries within five years of their occurrence. Thus, it is maintained that § 5-109 can only be valid if it furthers a compelling state interest, thereby withstanding strict scrutiny. See Attorney General v. Johnson, supra,
In Whiting-Turner Contracting Co. v. Coupard,
“The ‘law of the land’ in Article 19 is the same due process of law required by the fourteenth amendment ... and we simply cannot conclude that the additional ex-pense and delay mandated by this malpractice claims statute is so unreasonable in relation to its legitimate goal that it contravenes due process.”282 Md. at 298-99 ,385 A.2d 57 (citation omitted).
We noted in Johnson that in Zablocki v. Redhail, supra, the Supreme Court observed that strict scrutiny is only applied when a statutory classification significantly interferes with the exercise of a fundamental right.
Hill undertakes to distinguish Johnson from the present case, arguing that the arbitration requirement merely creates a precondition to the exercise of the right of access whereas § 5-109 “destroys” that right. This contention is directly contrary to Allen v. Dovell,
“It is thoroughly understood that a statute of limitations, which does not destroy a substantial right, but simply affects remedy, does not destroy or impair vested rights.... It is true that the Legislature cannot cut off all remedy and deprive a party of his right of action by enacting a statute of limitations applicable to an existing cause of action in such a way as to preclude any opportunity to bring suit. However, the Legislature has the power to amend a statute of limitations either by extending or reducing the period of limitations, so as to regulate the time within which suits may be brought, provided that the new law allows a reasonable time after its enactment for the assertion of an existing right or the enforcement*703 of an existing obligation.” Id. at 363-64,66 A.2d 795 (citation omitted).
As the common law is subject to legislative change, there is no vested right in any common law rule. Munn v. Illinois, 94 U.S. (4 Otto) 113, 134,
CERTIFIED QUESTIONS ANSWERED AS HEREIN SET FORTH; COSTS TO BE DIVIDED EQUALLY BETWEEN THE PARTIES.
Notes
. Section 5-101, in its entirety, reads as follows:
“A civil action at law shall be filed within three years from the date it accrues unless another provision of the Code provides a different period of time within which an action shall be commenced.”
. Section 5-109 expressly provides that if a claimant was under 16 years of age at the time the injury was committed, "the time shall commence when he reaches the age of 16.”
. That the legislature is empowered to change the common law is, of course, well settled. See Pope v. State,
. The great majority of jurisdictions that have considered the constitutionality of state statutes limiting the time within which suit must be filed in medical malpractice cases have upheld them. See e.g., Brubaker v. Cavanaugh,
Some cases have found statutes like § 5-109 to be constitutional where challenged on the basis of an "open courts" provision in the state constitution similar to Art. 19 of the Maryland Declaration of Rights. See e.g., Hargett v. Limberg,
Other jurisdictions deciding that similar statutes were unconstitutional include Kenyon v. Hammer,
Concurrence Opinion
concurring:
I concur in the result and in the Court’s opinion except Part IY.
