In this сase we are asked to determine when an action accrues in a medical products liability case. Pursuant to the Uniform Certification of Questions of Law Act, Maryland Code (1984), §§ 12-601 to 12-609 of the Courts and Judicial Proceedings Article, the United States District Court for the District of Maryland certified the following question of state law for our consideration.
Whether under the discovery rule, knowledge of the manufacturer’s wrongdoing or of product defect is required, in addition to knowledge of possible causation, to trigger the statute of limitations in a medical products liability action.
We set forth the following facts to place the question presented in proper focus. On June 17, 1980, Evangelia Nasios was admitted to Holy Cross Hospital to deliver her second child. Prior to delivery, Nasios received an epidural injection of the anesthetic Nеsacaine, a drug supplied by Pennwalt Corporation (Pennwalt). Within hours after childbirth it became apparent that Nasios was partially paralyzed. In an effort to remedy the paralysis, her doctors performed an emergency laminectomy the following day to correct an epidural hematoma. 1 However, the surgery did not improve Nasios’s condition. Five days later, a doctor at the hospital explained to Nasios that her prognosis was not bright and that the epidural anesthesia may have been the cause of her paralysis. 2 Nasios hired an attorney shortly thereafter and began investigating her possible claims. On July 17, 1985, over five years after her injury, and after *436 changing attorneys several times, Nasios filed a breach of warranty, negligence, and strict liability suit against Pennwalt. Pennwalt asserted that Nasios’s claim was barred by limitаtions and moved for summary judgment.
Judge Ramsay, sitting for the United States District Court for the District of Maryland, summed up the crucial facts and his conclusions in the Certification Order. Judge Ramsay made clear that Nasios knew that Nesacaine was a possible cause of her paralysis more than three years before filing suit. Additionally, Nasios thoroughly investigated a possible claim against Pennwalt. Nevertheless, Judge Ramsay indicated that he could not conclude as a matter of law that Nasios had knowledge of the alleged manufacturer wrongdoing or product defect more than three years before filing suit. From the foregoing, Judge Ramsay concluded that if knowledge of possible causation is all that is required to trigger the running of the statute of limitations, then summary judgment should be granted in favor of the defendants. On the other hand, if the plaintiff must have knowledge of manufacturer wrongdoing or product defect before the statute of limitations begins to run, he suggested that summary judgment would be inappropriate. Judge Ramsay found that there was insufficient Maryland law on this point and therefore certified to us the question of whether knowledge of a manufacturer’s wrongdoing or product defect is necessary to begin the running of the limitations period.
Pennwalt would have us answer the certified question with an unequivocal “no.” It argues that a cause of action accrues when a potential plaintiff discovers his injury and there is no requirement that he need know of any manufacturer wrongdoing or product defect. Nasios would have us answer the certified question with a qualified “no.” Nasios argues that the statute of limitations does not begin to run on a potential plaintiff until the injury, possible cause of the injury, and knowledge of probable wrongdoing are discovered or should have been discovered through reasonably diligent investigation. Nasios qualifies her “no” answer to *437 the certified question because, in Nasios’s view, the question requires express knowledge of wrongdoing, and Nasios recommends a standard of express or implied knowledge which contemplates knowledge of what a reasonably diligent investigation would have revealed.
The statute we must construe, Maryland Code (1984), § 5-101 of the Courts and Judicial Proceedings Article, is rather straightforward: “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.” The meaning of the key term “accrues,” however, has not been legislatively defined, leaving the task of determining when an action accrues to the judiciary.
Pierce v. Johns-Manville Sales Corp.,
I
Statutes of limitations have existed in Maryland and in other common law jurisdictions for hundreds of years.
See
Ferguson,
The Statutes of Limitation Saving Statutes,
12-14 (1978). The statutes were enacted in an effort to balance the competing interests of potential plaintiffs, potential defendants, and the public. The statutory period provided by a statute of limitations represents a compromise of these interests and “reflects a policy decision regarding what constitutes an adequate period of time for a person of ordinary diligence to pursue his claim.”
Goldstein v. Potomac Electric Power Co.,
Historically, the general rule in Maryland was that an action accrued on the date of the wrong.
Hahn v. Claybrook,
We later recognized that the date of the wrong rule did not provide equitable results in all cases. Consequently, we created the “discovery rule” as an exception to the general rule. Although we first intimated our adoption of the discovery rule in
Hahn,
a medical malpractice case, it was not until
Waldman v. Rohrbaugh,
The Waldman Court declined the defendant’s invitation to аpply the date of the wrong rule and stated:
“The effect of ... [the date of the wrong rule] has frequently been to bar the plaintiff’s claim not only before he sustained any perceptible harm, but before it was feasible for him to learn that the negligence had taken place____ Especially where the plaintiff is unqualified to ascertain the imperfection, as in the case of negligent performance of expert or professional services, it seems harsh to begin the period at the time of the defendant’s act.”
Id.
at 140,
Consequently, our predecessors in
Waldman
adopted the discovery rule as an exception to the date of the wrong rule in cases of medical malpractice. The Court noted that its newly adopted exception would not postpone accrual in many cases because a plaintiff would often know or have reason to know “soon after the wrongful act that he has been the victim of negligent medical care.”
Id.
at 145,
*440 In redefining the accrual point in medical malpractice cases, the Waldman Court realized that accrual at the time of the wrong did not provide an adequate opportunity for a diligent plaintiff to bring suit because he may be unaware during the statutory period that he has been injured. In repositioning the date of accrual, the Court was careful to preserve for diligent plaintiffs the full statutory period within which to bring suit. The Court therefore held that an action accrues when the victim knows or should have known the defendant rendered negligent medical care, not merely medical care. That is, limitations are triggered when the plaintiff knows or should have known that he has a cause of action.
After our adoption of the discovery rule in
Waldman,
we applied the same rationale to extend the discovery rule exception to other professional malpractice cases.
See, e.g., Mattingly v. Hopkins,
The development of the discovery rule continued in
Harig v. Johns-Manville Prods. Corp.,
*441
The
Harig
Court traced the history of the discovery rule in Maryland and reviewed its prior application to professional malpractice cases. The Court recognized that the discovery rule “ ‘gives to the individual exercising reasonable diligence the full benefit of the statutory period in which to file suit, while at the same time protecting the defendant from “stale claims,” as was intendеd by the statute.’ ”
Id.
at 79,
Like the victim of undiscoverable malpractice a person incurring disease years after exposure cannot have known of the existence of the tort until some injury manifests itself. In neither case can the tort victim be charged with slumbering on his rights, for there was no notice of the existence of a cause of action.
Id.
Like the Waldman Court, the Harig Court was careful to preserve a diligent plaintiff’s right to bring suit. The Harig Court stated that a plaintiff must be aware “that a tort has occurred,” and not merely that an injury has occurred. The Harig Court also made clear that an action accrues when the “nature and cause of the injury,” and not merely when the nature of the injury, are known or should have been known.
*442
The discovery rule finally evolved from the exception to the general rule in
Poffenberger v. Risser,
The defendant argued that the action accrued when construction on the house began in 1972 or later that year when the plaintiff moved into the house. The plaintiff, on the other hand, argued that the discovery rule was applicable and the action did not accrue until his neighbor’s lot was surveyed. We reviewed that history of the discovery rule in Maryland and noted its growth from medical malpractice cases to all professional malpractice cases and then also to latent disеase cases. We saw no reason to limit the discovery rule’s equitable effect to those cases and thus adopted it as the general rule.
We stated in
Poffenberger
that a “cause of action accrues when the claimant in fact knew or reasonably should have known of the wrong.”
Id.
at 636,
Our development of the discovery rule did not stop with
Poffenberger.
Two years later we applied the discovery rule in
Pierce v. Johns-Manville Sales Corp.,
The defendant argued that Pierce’s action accrued when he developed asbestosis. At that point, argued the defendant, Pierce knew or should have knоwn of later injury he would suffer from lung cancer. The plaintiff argued that although asbestosis and lung cancer are both associated with exposure to asbestos, there is no medically accepted link between developing asbestosis and lung cancer, and thus he had no way of knowing he would develop lung *444 cancer at that time. Pierce maintained that his action accrued when he was diagnosed as having lung cancer in late 1979.
We began our analysis in
Pierce
by reiterating our test for determining when an action accrues — when the plaintiff knew or reasonably should have known of the nature and cause of the harm.
Id.
at 663,
The adoption of statutes of limitation reflects a policy decision regarding what constitutes an adequate period of time for a person of reasonable diligence to pursue a claim. Such statutes are designed to balance the competing interests of each of the potential parties as well as the societal interests involved. Thus, one of the purposes of such statutes is to assure fairness to a potential defendant by providing a certain degree of repose. This is accomplished by encouraging promptness in prosecuting actions; suppressing stale or fraudulent claims; avoiding inconvenience that may stem from delay, such as loss of evidence, fading of memories, and disappearance of witnesses; and providing the ability to plan for the future without the uncertainty inherent in potential liability. Another basic purpose is to prevent unfairness to potential plaintiffs exercising reasonable diligence in pursuing a claim. Still another purpose is to promote judicial economy.
Id.
at 665,
In analyzing the competing interests, we recognized that defendant repose would be somewhat fostered by holding that the action accrued when the asbestosis surfaced. We also reasoned, however, that it would be unjust to require Pierce to seek damages for lung cancer at the time he discovered asbestosis because lung cancer is a separate and distinct disease from asbestosis. Maryland law does not allow for damages based on mere possibility, and at the time Pierce discovered he had asbestosis there was no medical evidence that would show there was a probability that he would develop lung cancer. Thus, it would have
*445
been fruitless for him to sue at that time to recover damages for possible future lung cancer. We determined that if Pierce’s action accrued at the time he discovered he had asbestоsis, his “right to recover for the latent disease of lung cancer would, as a practical matter, be nullified.”
Id.
at 667,
We found that this result “affords a reasonably diligent person, who is unable to discover the existence of a latent disease,
the full benefit of the statutory period in which to file suit,
retains some degree of protection of a potential defendant’s right to repose, and promotes judicial efficiency.”
Id.
at 668,
Pierce was a strong amplification of our prior discovery rule cases. It applied our time-tested policy concerns and carefully weighed each factor. The test we laid out there requires the plaintiff to know or have reason to know (1) that he has suffered injury and (2) that the injury was caused by the defendant. Pierce thus sums up the rationale of our prior cases and stands in line with Waldman, Harig, and Poffenberger in preserving for plaintiffs the full statutory period within which to bring suit.
We reaffirmed our
Pierce
decision two years later in
Smith v. Bethlehem Steel Corp.,
In reaching our decision in Smith we reviewed Pierce, and again wеighed the conflicting policy considerations underlying the statute of limitations. We found that because the damages for cancer were sought during the pendency of the asbestos suit, the defendants’ interest in repose was not as strong. We recognized that the interest of a diligent plaintiff to bring suit, however, would be just as strong. In both Smith and Pierce the plaintiffs would be put in a Catch-22 position if their actions accrued at the time asbestosis developed — if the plaintiffs brought suit then, they could not put on proof of the degree of likelihood that cancer would ensue, and if they were to wait until cancer developed, they would be barred by limitations. We also found that the third factor to be weighed, society’s interest in judicial economy, was just as strong in Smith as it was in Pierce. Consequently, we held that as long as Smith could prove that colon cancer, like lung cancer, was a latent disease separate and distinct from asbestosis, his action for damages from cancer did not accrue until his cancer was discovered.
Subsequent to
Smith,
we decided
O’Hara v. Kovens,
As a preliminary matter in O’Hara, we discussed the proper timing of the accrual of a cause of action in light of the defendants’ argument that the plaintiffs “reasonably should have known of the wrong” more than three years before filing suit. Stated another way, when does the statute of limitations begin to run when the plaintiff’s knowledge of the wrong is implied from the circumstances. In regard to this question we first looked to the language from Poffenberger where we stated that a plaintiff reasonably should have known of the wrong if the plaintiff has
knowledge of circumstances which ought to have put a person of ordinary prudence on inquiry [thus, charging the individual] with notice of all facts which such an investigation would in all probability have disclosed if it had been properly pursued.
Poffenberger,
Since the proper scope and function of the inquiry notice rule is of vital importance to an understanding of the operation of the discovery rule in the case sub judice, we will take this opportunity to elaborate on the specific circumstances under which the inquiry notice rule will start the running of the statute of limitations. To illustrate our point we will examine the facts of the Levy case.
In October, 1973, Ms. Levy broke her ankle and had it put in a cast at Lutheran Hospital. Shortly thereafter, a physician at the hospital told her to throw away her crutches and walk on the ankle. Ms. Levy, however, had continuing trouble with the ankle and consulted a physician at Mercy Hospital in April, 1974, who advised Ms. Levy that her ankle “was all messed up” and asked her “who the hell told her to walk on that ankle?” She was also advised that the condition of her ankle would not improve. Notwithstanding this information, Ms. Levy did not consult an attorney until early 1975. Furthermore, it was not until July, 1977, that Ms. Levy’s treating physician examined the x-rays taken of Ms. Levy’s ankle at Lutheran in 1973 and concluded that Ms. Levy was the victim of medical malpractice. Ms. Levy did not file suit until June, 1978.
From these facts it is clear that: (1) a reasonably prudent person, with knowledge of all the facts and circumstances available to Ms. Levy following her consultation with the physician at Mercy Hospital, would have undertaken further investigation to learn if legal action against the physician from Lutheran was justified; and (2) had Ms. Levy immediately engaged in a reasonably diligent investigation, she would have discovered that she was the victim of negligent medical care. Therefore, in simple terms, a plaintiff is only on inquiry notice, and thus the statute of limitations will begin to run, when the plaintiff has “knowledge of circumstances which would cause a reasonable person in the position of the plaintiff[] to undertake an
*449
investigation which, if pursued with reasonable diligence, would have led to knowledge of the alleged [tort].”
O’Hara,
Applying the inquiry notice rule to the facts presented in O’Hara, and in light of the defendants’ motion for summary judgment in that case, the defendants had the burden of proving that more than three years before filing suit (1) the plaintiffs knew of facts sufficient to cause a reasonable person to investigate further, and (2) a diligent investigation would have revealed that the plaintiffs were victims of fraud, the alleged tort. The defendants offered various newspaper articles published more than three years before the suit was filed in an attempt to prove this latter proposition. The plaintiffs conceded that the statute of limitations would start to run as of the date of inquiry notice. However, the plaintiffs asserted that they were first on inquiry notice within three years of filing suit.
In addressing whether summary judgment in favor of the defendants on the limitations issue was proper, we initially clarified a point of confusion in the lower courts. Specifically, we indicated that the court has the exclusive power to
*450
determine the manner of operation of the discovery rule in different types of cases,
O’Hara,
Subsequent to
O’Hara,
operation of the inquiry notice rule was brought into question in
Baysinger v. Schmid Products Co., 307
Md. 361,
At the time of the plaintiff’s hospitalization, she questioned her treating physician and his associate as to whether the device had caused her illness. The plaintiff was advised that there could be several possible causes and, although intrauterine devices had been associated with pelvic infections in medical literature, there was no way of determining whether her infection was caused by the SafT-Coil. Four years later, in January, 1983, the plaintiff received notice of possible causation through an advertise *451 ment in a local newspaper. At that time, the plaintiff retained counsel and filed suit.
The defendant, Schmid Products, filed a motion for summary judgment arguing that the statute of limitations had expired. The trial court granted the motion and was affirmed by the Court of Special Appeals in an unreported оpinion. On appeal to this Court, we found that the trial judge erred in concluding as a matter of law that the plaintiff had notice of her cause of action in late 1979. Our reversal was based on the finding that a question of fact existed as to the point in time in which Mrs. Baysinger had knowledge of circumstances which would cause a reasonable person in her position to undertake an investigation which, if pursued with reasonable diligence, would have led to knowledge of the wrong. We reasoned as follows:
While the sparse record of facts before the trial judge demonstrated that Mrs. Baysinger’s suspicions concerning the cause of her infection included the intrauterine device, it also showed that she initiated a preliminary investigation by discussing her suspicions with Dr. Cho, and that Dr. Cho told her he had “no way of determining whether her infection was cаused by the Saf-T-Coil or by some other unrelated occurrence or instrumentality.” The record further discloses that at that time Dr. Gallaher had no idea of what caused her illness, and consequently further investigation by way of inquiry of Dr. Gallaher would have been fruitless. We further note that while the record indicates that Mrs. Baysinger entertained various suspicions concerning the cause of her illness, there is no evidence that she then suspected, or reasonably should have suspected, wrongdoing on the part of anyone. Whether a reasonably prudent person should then have undertaken a further investigation is a matter about which reasonable minds could differ, and it was therefore inappropriate for resolution by summary judgment.
Id.
at 367-68,
II
Our review of the preceding cases reveals that the discovery rule has evolved as a means of mitigating the often harsh and unjust results which flow from a rigid application of the statute of limitations. It is likewise clear that this Court is empowered to define the operation of the discovery rule to further its purposes under varying factual circumstances.
Poffenberger, supra; Trimper v. Porter-Hayden,
Moreover, this approach is consistent with our prior cases as well as practical considerations. In
Waldman,
In terms of the policy considerations underlying the statute of limitations, we have historically been concerned with three factors. Those factors, again, are: (1) the interest of diligent plaintiffs to bring suit; (2) the interest of defendants to enjoy repose after an unreasonable delay by plaintiffs; and (3) the interest of society in promoting judicial economy.
In analyzing the first consideration, we find that a products liability plaintiff, asserting negligence and strict liability, would be inequitably penalized if the limitations period began to run before he should reasonably discover manufacturer wrongdoing or a product defect. To bring a negligence action, a plaintiff must prove: (1) a duty owed by the defendant to the plaintiff; (2) a breach of that duty by the defendant; (3) an injury to the plaintiff; and (4) that the injury was proximately caused by the defendant’s breach of duty.
Read Drug Co. v. Colwill Constr.,
Similarly, for a plaintiff to bring a strict liability claim for product liability he must show,
inter alia,
(1) that the plaintiff was injured; (2) that the product was defective;
*454
and (3) that the product defect caused the injury.
Phipps v. General Motors Corp.,
We find that a plaintiff who cannot discover manufacturer wrongdoing or product defect through a reasonably diligent investigation is in the same predicament as the plaintiffs in Pierce and Smith. Just as Pierce and Smith could not have recovered for damages related to cancer before cancer developed, a plaintiff who cannot establish a breach of duty by the defendant or a product defect cannot recover for harm done in a medical products liability case. Thus, the plaintiff is put in a Catch-22 position — if he files suit within three years of discovery of the nature and cause of his injury he will have no proof of breach of duty or product defect and will be denied a remedy, and if he waits until he gains the necessary knowledge of the defendant’s breach of duty or product defect, the statute of limitations will bar his suit. We therefore find that the first factor weighs heavily in favor of the positiоn that a medical products liability action does not accrue until the plaintiff knows or should know of the manufacturer wrongdoing or product defect.
The second factor we must consider is a defendant’s interest in repose. Here we are concerned with the inconvenience and unfairness to defendants that stem from delay in bringing suit, and the need for defendants to be free of ancient liabilities so as to be able to plan for the future without the uncertainty inherent in potential liability. We find the defendant’s interest in repose is not significantly hindered by holding that a medical products liability action does not accrue until the plaintiff knows or should know of manufacturer wrongdoing or product defect.
*455
The inconvenience and unfairness to defendants that occur because of delay in bringing suit is primarily due to the loss of evidence, fading of memories, and disappearance of witnesses. In a medical products liability case, much of the evidence will be documentary, such as hospital records and charts and manufacturer testing reports and procedure manuals. This type of evidence is normally readily available and there is little chance of it becoming lost. Concomitantly, the fading of witnesses’ memories and disappearance of witnesses becomes less important. And, to a certain extent, witnesses’ memories may be refreshed in many cases by reviewing the relevant documentary evidence. Thus, the delay caused by allowing a suit to be brought three years after a medical products liability plaintiff knows or should know of manufacturer wrongdoing or product defect results in little inconvenience or unfairness to defendants.
Accord Bonney v. Upjohn Co.,
Allowing an action tо accrue at the time a plaintiff knows or should know all the elements of his cause of action, however, does keep a defendant shackled to long past liabilities and hinders a defendant’s ability to plan for the future. When a medical products liability defendant confronts potential liability years after it has made and sold a product, it faces a contingent liability that is difficult to quantify and which may materialize at almost any time. Consequently, financial planning is burdened. Thus, defendants in medical products liability actions have a legitimate interest in starting the limitations clock as soon as possible.
To resolve this conflict, we examine society’s interest. We find that judicial economy would be promoted by starting the limitations period at the time a plaintiff knows or should know he has a cause of action. Thus, generally, a cause оf action for a plaintiff in a medical products liability action would accrue when he knew or should have known (1) he suffered injury; (2) the injury was caused by the *456 defendant; and (3) there was manufacturer wrongdoing or a product defect. To hold otherwise we would encourage, indeed almost force, a person who is injured by a drug to immediately file suit against the manufacturer without knowledge of manufacturer wrongdoing or a product defect, in order to prevent the statute of limitations from running. Injured persons would become plaintiffs against every possible party without knowledge of wrongdoing or product defect in hope that such evidence would eventually emerge. As a result, the courts would be crowded with potentially frivolous claims. This result is not consistent with the unarguably sound position that unfounded claims should be discouraged. We believe it would bе more efficient to allow the plaintiff the statutory period to bring suit from the time he discovers or should have discovered he has a cause of action. This rule would not encourage plaintiffs to bring suit too early and would prevent plaintiffs from bringing suit too late because they would be required to be diligent in their investigations. Thus, our judicial time would be most efficiently spent.
A weighing of these three interests in a products liability case dictates that fairness to diligent plaintiffs and the promotion of judicial efficiency outweigh defendants’ interest in repose, and therefore, an action accrues when the plaintiff knew or should have known he had a cause of action. See Harig, supra. In the case of products liability, this requires express or implied knowledge of manufacturer wrongdoing or product defect.
We return then to the certified question:
Whether under the discovery rule, knowledge of the manufacturer’s wrongdoing or of product defect is required, in addition to knowledge of possible causation, to trigger the statute of limitations in a medical products liability action.
If the District Court used the word knowledge to mean clear and unequivocal proof that a certain manufacturer’s negligence produced a defective product causing the plain *457 tiff’s injury, then we would answer the question no. If use of the term knowledge means express or implied knowledge of injury, its probable cause, and probable manufacturer wrongdoing or product defect, then we would answer the question yes.
CERTIFIED QUESTION ANSWERED AS HEREIN SET FORTH; COSTS TO BE DIVIDED EQUALLY BETWEEN THE PARTIES.
Notes
. One expert, T. Crawford McAslan, concluded that Mrs. Nasios’s paralysis resulted from nerve damage caused by the epidural hematoma.
. Dr. Chong Lee, an anesthesiologist, made the following entry in Nasios’s progress notes on June 22, 1980:
Severаl cases [sic] report[s] reported in Anthesia and Analgesia (Vol. 59, No. 6, June 1980) Journal similar to Mrs. Nasios’s case was [sic] found and explained to patient who seems to be aware of not bright prognosis.
. The roots of this exception can be traced to this Court's early cases in equity involving claims of fraud. In those cases, the discovery rule was applied to bar the running of the statute of limitations.
See, e.g., Franklin
v.
Waters,