Lead Opinion
In this appeal, we must decide if the district court correctly granted summary judgment in a medical malpractice action based on a claim that the plaintiffs failed to file their petition within the statute of limitations. Although the district court relied on our line of prior cases in reaching its decision, we now conclude the statute of limitations for medical malpractice actions does not begin to run until discovery of both the injury and its factual cause. On our review, we reverse the decision of the district court and remand for further proceedings.
I. Background Facts and Proceedings.
On March 19, 1999, Kelly and Richard Rathje admitted their sixteen-year-old daughter, Georgia, to an outpatient alcohol abuse treatment center at Mercy Hospital in Cedar Rapids. Part of the treatment plan developed for Georgia called for the administration of a drug called Antabuse. This drug causes the body to produce an alcohol sensitivity that results in a highly unpleasant reaction to the ingestion of beverages containing alcohol. The treatment plan called for Georgia to receive a liquid dose of Antabuse, administered by a nurse at the treatment center, twice each week.
Around a week later, Georgia began to feel sick and nauseated. She also began to experience cramps and was constipated. Georgia reported these symptoms to the nurse who administered the Antabuse at the treatment center, and the nurse suggested she consume food prior to taking Antabuse in the future.
On April 5, Kelly contacted the family’s physician, Dr. Jerome Janda, to report Georgia was nauseated and frequently expelled an acid-like fluid from her stomach. Dr. Janda subsequently examined Georgia, and ordered an upper gastrointestinal test. The results of the test were consistent with peptic disease and duodenitis, but revealed no definite ulcer or reflux disease. Dr. Janda prescribed medication for Georgia’s stomach pain.
On April 20, Georgia would not eat or drink. She was suffering from abdominal pain and was vomiting a green substance. She was also fatigued. Kelly reported these symptoms to a nurse in Dr. Janda’s office.
On April 26, Georgia returned to Dr. Janda’s office. She had been bedridden for most of the time since the previous office visit on April 23. She was nauseated, vomiting, and constipated. At this visit, Dr. Janda noticed Georgia’s skin color was “mildly yellow or jaundiced and the whites of her eyes were yellowish or icteric.” He again ordered the prior tests and added a test to determine the presence of any inflammation.
Georgia had blood drawn for testing at Mercy Hospital. The blood tests were performed by the hospital lab, with abnormal results. Dr. Janda informed Kelly of the test results, and Georgia was admitted to St. Luke’s Hospital on April 27.
Dr. Janda consulted with a surgeon about his concern that Georgia could have gallbladder stones. A CAT scan revealed some enhancement of the gallbladder wall and some fluid around the gallbladder, but no other abnormalities. The surgeon then consulted with a gastroenterologist.
The gastroenterologist determined the jaundice and elevated liver enzymes experienced by Georgia were secondary to hepatitis. He believed Georgia’s condition might be a “drug-induced hepatitis secondary to Antabuse.” He recommended Georgia stop taking all prior medications.
Georgia was discharged from St. Luke’s Hospital, but promptly readmitted on April 29. She still appeared jaundiced, and her condition continued to deteriorate over the passing days. On May 5, she was transferred to the University of Iowa Hospitals and Clinics Pediatric Intensive Care Unit. She later received a liver transplant as a result of end-stage liver disease secondary to Antabuse.
On April 26, 2001, Georgia and her parents filed a petition against numerous health care providers, including Mercy and Dr. Dwight Schroeder, the medical director at the Alcohol Treatment Center at Mercy. The lawsuit claimed Dr. Schroeder and the hospital were negligent in prescribing Antabuse and in their treatment of Georgia for alcohol abuse, and this negligence was the cause of her irreversible liver damage and transplant. The Rathjes eventually dismissed all defendants from the lawsuit except Mercy Hospital and Dr. Schroeder.
Mercy Hospital and Dr. Schroeder filed answers to the petition and later were permitted to amend their answers to claim the statute-of-limitations defense. They both then subsequently moved for summary judgment based on the two-year statute of limitations.
Mercy Hospital and Dr. Schroeder claimed the statute of limitations began to run when Georgia began to experience symptoms of her injury prior to April 26, 1999. Georgia and her parents claimed the statute of limitations began to run when Georgia learned after April 26, 1999, her liver was irreversibly damaged, or, at the earliest, when her condition worsened on April 26, 1999, to include symptoms of jaundice.
The district court granted summary judgment for Mercy Hospital and Dr. Schroeder. It found the facts were undisputed that Georgia’s injury had physically manifested itself well prior to April 26, 1999, more than two years before the Rathjes filed suit. Consequently, it concluded the lawsuit filed by the Rathjes was barred by the statute of limitations con
The Rathjes appealed. They argue the district court erred in allowing Mercy to amend its answer to include a statute-of-limitations defense and further argue the district court erred in granting summary judgment for Mercy Hospital and Dr. Schroeder.
II. Standard of Review.
We review a district court ruling granting a motion for summary judgment for correction of errors at law. Kragnes v. City of Des Moines,
III. Statute of Limitations for Medical Malpractice Actions.
This case requires us once again to visit the medical malpractice statute of limitations and apply it to the facts of a particular case. We have done this on a number of occasions since the special statute was enacted in 1975, and have developed a body of interpretative law in the process. Yet, this law has raised some questions about the fairness of the outcome of a number of these cases. This perception has not gone unnoticed by us, for we have freely acknowledged the statute can “severely restrict! ] the rights of unsuspecting patients.” Schlote v. Dawson,
It is, of course, the role of the legislature to write statutes, and it is our role to interpret them based on their application in the course of litigation. Moreover, the legislature can rewrite a statute to reflect its intent when it does not believe our interpretation in a particular case has accomplished this goal. Yet, these general principles of separation of powers and fundamental duties do not totally absolve us from our continued responsibility to interpret applicable statutes in each case and, more importantly, to revisit our past interpretations if we are convinced they have not clearly captured the intent of our legislature. We adhere to precedent, but also remain committed to clarifying the law as we work with our precedent. When our interpretation of a statute has created problems in the application of the statute to subsequent cases, we should be willing to reexamine our precedent to see if our understanding of the legislative intent can be better articulated. See Ruth v. Dight,
We begin the task of revisiting our interpretation of section 614.1(9) by returning to the original statute of limitations for personal injury actions enacted
“The following actions may be brought within the times herein limited, respectively, after their causes accrue, and not afterwards, except when otherwise specially limited: (1) Actions founded on injuries to the person ..., whether based on contract or tort, ... within two years.”
Fadden v. Satterlee,
While the legislature prescribes the period of limitation, courts have generally been called upon to determine when a claim accrues to start the running of the statute of limitations. See Roberts v. Sw. Cmty. Health Servs.,
The first rule to emerge from our early statute-of-limitations cases was that a claim accrued when the injured party had a “right to institute and maintain a suit.” Chrischilles v. Griswold,
We also observed early on that the tor-tious act committed by a defendant was not always immediately followed by the resulting injury. Ogg v. Robb,
This approach was logical because the injury would not always occur at the same time as the wrongful act, but no cause of action could' accrue until the injury occurred. Ogg,
In Ogg, the plaintiff suffered burns, on his arms as a result of x-rays taken by the doctor after he broke his wrist.
that where the party against whom a cause of action existed in favor of another, by fraud or actual fraudulent concealment prevented such other from obtaining knowledge thereof, the statute would only commence to run from the time the right of action was discovered, or might, by the use of diligence, have been discovered.
Dist. Twp. of Boomer v. French,
During the time we maintained allegiance to the bright-line rule that the statute of limitations for personal injury actions commenced at the time the injury occurred, we began to develop a body of law surrounding the common-law discovery rule. In applying the discovery rule to the specific legislative exceptions, we held that actual knowledge of the fraud and other wrongs was not required before the statute of limitations began to run. Instead, we declared:
The “discovery” of the fraud or wrong which will set the statute in motion does not necessarily mean actual and direct personal knowledge by the complaining party. It is sufficient if such party has such knowledge or notice as would lead a man of reasonable prudence to make inquiries which would disclose the fraud.
Van Wechel v. Van Wechel,
While the discovery rule began to take root in Iowa, its impact on the general statute of limitations remained limited. Other jurisdictions, however, began to apply the “discovery rule” to the general statute of limitations for personal injury tort claims. This broader application of the discovery rule was in response to the harshness of the prevailing rule to unsus
was a sufficient indication of an injury, to have put her upon notice and inquiry, and it is clear from the evidence that if she had exercised ordinary care and diligence to have ascertained her rights, she could have discovered the cause of her alleged injury.
Id. at 86. Consequently, the court held the statute of limitations began to run at the time the plaintiff first noticed her skin discoloration in 1908, not when the doctor began prescribing the drug. Id.
The application of the discovery rule to the general statute of limitations grew in popularity throughout the Twentieth Century, although not all jurisdictions utilized the same event to trigger the statute of limitations under the discovery rule. See Roberts,
In 1967, Iowa joined the parade of states to apply the discovery rule to the general statute of limitations. In Chrischilles, we recognized the national trend toward adopting the discovery rule as the better approach for claims based on negligence.
Seven years later, we applied the discovery rule to the general statute of limitations in a medical malpractice action. In Baines v. Blenderman,
The doctor moved for summary judgment based on the statute of limitations, and Baines invoked the discovery rule. Id. at 201. Baines claimed he was unaware of his cause of action under the discovery rule adopted in Chrischilles until he was informed on July 15, 1970, that his injury was permanent and he learned how it likely occurred. Id. The doctor claimed the statute of limitations began to run when Baines awoke from surgery because this was the date he knew of his injury (blindness) and knew it resulted from surgery. Id. Thus, the question was whether discovery of the cause of action, to commence the running of the statute of limitations, should include the element of the negligence of the physician.
We resolved the dispute over the application of the discovery rule by holding that a claim did not accrue under the discovery rule to trigger the statute of limitations until the plaintiff knew or should have known of the existence of the cause of action. Id. at 202. More specifically, we held a plaintiff must not only discover the injury and its cause, but must also discover the physician was negligent. Id. Yet, we reached this conclusion without acknowledging the rule followed in other jurisdictions that discovery of the injury and its factual cause triggers the statute of limitations. See Kubrick,
Importantly, at the time Baines was decided, two movements had surfaced in courts around the nation as a result of the discovery-rule trend sweeping the country. First, two main distinct legal theories emerged from our nation’s state and federal courts to govern the triggering event for the discovery rule. Conceptually, the national movement responsible for introducing the discovery rule into the statute of limitations merely transformed the commencement of the limitation period from the date the elements of the cause of action occurred to the date the elements were discovered. The difficult subissue, however, was how the discovery rule should be applied to the elements of the claim, i.e., whether or not it should be applied to all of the elements. Most state courts, as we did in Baines, triggered the discovery rule upon knowledge of the
More importantly, many courts failed to precisely describe the full meaning of their rule governing the breadth of knowledge required to trigger the statute of limitations, which has made it difficult at times to discern which rule was actually followed. Instead, courts in the discovery rule era would refer to their accrual rule in shorthand, just as we did in describing when a cause of action accrued prior to the adoption of the discovery rule. For instance, courts would simply declare the statute of limitations commenced upon discovery of the “injury,” when a full articulation of the rule would have revealed whether they required discovery of all the elements of the cause of action, or merely discovery of the injury and its cause. This phenomenon was aptly described by the New Hampshire Supreme Court:
One might read several discovery cases and conclude that the courts are applying two substantively distinct rules. In most cases the courts frame the rule in terms of the plaintiffs discovery of the causal relationship between his injury and the defendant’s conduct. In some cases, ... a court will state simply that, under the discovery rule, a cause of action accrues when the plaintiff discovers or should have discovered his injury. Still other courts use both statements of the rule within the same case. The reason for these apparent differences is that in most cases in which the court states the rule in terms of the discovery of the injury, the injury is the kind that puts the plaintiff on notice that his rights have been violated. Thus, there is no reason for the court to express the rule in terms of the discovery of the causal connection between the harm and the defendant’s conduct. In a case, such as the one before us, in which the injury and the discovery of the causal relationship do not occur simultaneously, it is important to articulate exactly what the discovery rule means. We believe that*454 the proper formulation of the rule and the one that will cause the least confusion is the one adopted by the majority of the courts: A cause of action will not accrue under the discovery rule until the plaintiff discovers or in the exercise of reasonable diligence should have discovered- not only that he has been injured but also that his injury may have been caused by the defendant’s conduct.
Raymond v. Eli Lilly & Co.,
The national trend of using the term “injury” to describe the triggering event under the discovery rule not only meant the term continued in its former capacity as a designation of the time of accrual, but it continued to reflect a larger meaning than the concept of physical harm. Yet, on occasion, this background was not fully captured, which gave rise to the suggestion from time to time that the discovery rule only looked to the injury to commence the running of the period of limitation, without any requirement of knowledge of its cause or the physician’s wrongdoing. See Lillicrap,
The second circumstance of importance at the time Baines was decided was the concomitant drumbeat of tort reform sweeping the country,- predicated on claims of a mounting medical malpractice crisis. See generally Anderson v. Wagner, 79 Ill.2d 295,
The reform became particularly relevant to Iowa after Baines made the discovery rule specifically applicable to medical malpractice cases. Thus, the Baines case set the stage for Iowa’s adoption of the national tort reform proposal of a statute to place an outside limit on the applicability of the discovery rule in medical malpractice actions.
In 1975, one year following Baines, the Iowa legislature enacted Iowa Code section 614.1(9)(a) as a specific exception to the general statute of limitations for malpractice actions against a specific group of medical personnel and medical facilities. See 1975 Iowa Acts ch. 239, § 26. The statute maintained the two-year limitation period, adopted the discovery rule, and placed a six-year period of repose on the applicability of the discovery rule as proposed by the reform movement. The statute of repose provided an outside limitation for all lawsuits, even though the injury had not been discovered.
Since the enactment of the statute, the dispute in Iowa has not involved the adoption of the discovery rule or the six-year period of repose. Instead, the dispute has mostly centered on the extent to which the legislature intended to restrict the triggering event for the two-year limitation. While the Iowa legislature adopted the discovery rule concept, it defined the rule to begin the two-year statute of limitations
In our first cases to address section 614.1(9) following its enactment, we observed the legislative purpose behind the statute was “to restrict the Baines discovery rule.” Schultze v. Landmark Hotel Corp.,
In Schultze, a patient was admitted to a hospital for treatment of a hip fracture and died seventeen days later.
Our first occasion to substantively address section 614.1(9) (a) in the context of a medical malpractice injury claim was Langner v. Simpson,
Subsection 9 means the statute of limitations now begins to run when the patient knew, or through the use of reasonable diligence should have known, of the injury for which damages are sought. The statute begins to run even though the patient does not know the physician had negligently caused the injury.
Id. at 517. We also formally read inquiry notice into the application of the statute and indicated the duty to investigate begins “once a person is aware that a problem exists.” Id. at 518. The “injury” claimed to have been suffered in Langner was posttraumatic stress disorder allegedly caused, in part, by the rude bedside statements of a treating psychiatrist. The plaintiffs “problem” surfaced so as to give rise to a duty to investigate at the time the conduct of the psychiatrist hurt her feelings, even though she did not understand the medical reasons why the conduct adversely affected her. Id.
We next made a passing reference to the statute of limitations for medical malpractice claims in McClendon v. Beck,
We next faced the statute in Schlote v. Dawson,
We last considered the statute of limitations in Ratcliff v. Graether,
As a whole, our cases interpreting section 614.1(9) have given rise to the rule that the statute of limitations begins to run when the plaintiff knows or, through the use of reasonable diligence, should have known of the physical harm. Langner,
In applying this case law to the undisputed facts of the summary judgment proceedings in this case, it is clear the Rathjes were placed on inquiry notice when Georgia was suffering from physical harm prior to April 26, 1999, more than two years prior to filing the petition. She was experiencing increasing signs of physical harm to her body, which an investigation revealed within two years from the time of the onset of the symptoms was caused by the administration of Antabuse. Under the rule applied in Schlote, the Rathjes failed to timely file their petition, even though they had no idea of the cause of the harm prior to the commencement of the statute of limitations. Thus, we are again faced with the prospect of applying the
Understanding the consequences of this state of the law, the Rathjes attempt to sidestep this result by arguing the relevant injury for the purpose of the statute of limitations is not the symptoms Georgia experienced prior to April 26,1999, but the later damage to her liver. They claim the liver damage is the injury that is the basis for the lawsuit, and this injury was not discovered, or could not have been reasonably discovered, until after April 26, 1999.
The approach advocated by the Rathjes gives rise to concerns about allowing plaintiffs to separate injuries and only leads to additional problems in an already troubled area of the law. See LeBeau v. Dimig,
While we agree with our prior observation that the enactment of section 614.1(9) was a “direct response to our decision ... in Baines,” the circumstances at the time of the enactment reveal the response was not primarily directed at the reasoning we used in Baines to support our adoption of the discovery rule. Instead, the legislature was largely reacting to the national movement for a statute of repose as a response to the prevailing trend toward the adoption of the discovery rule in medical malpractice cases. Baines, of course, made the movement particularly relevant in Iowa by 1975. Yet, there was no similar organized legislative movement that would indicate our legislature intended for the physical injury, alone, to serve as the triggering event under the discovery rule.
Nevertheless, the Baines decision did present a clear choice between two distinct triggering events. As mentioned, the doctor in Baines argued that the cause of action should accrue under the discovery rule when the patient knows or should know of the injury and that it was caused by medical care. Baines,
The actual debate over the triggering event reflected in the national case law at the time the legislature adopted section
In Kubrick, a patient brought a medical malpractice action under the Federal Tort Claims Act to recover for a loss of hearing that allegedly resulted from prior treatment he received for an infection to his leg. Id. at 113-15,
The district court and the United States Third Circuit Court of Appeals held the claim did not accrue under the two-year statute of limitations until the plaintiff discovered the possibility that the treatment provided by the physician was negligent (i.e., a breach of a legal duty), even though the patient knew of the injury and knew the physician was responsible for the injury. Id. at 115-16,
The United States Supreme Court rejected the concept that the discovery rule required knowledge of the actual legal cause before the statute of limitations began to run. It explained the rationale for only using discovery of the injury and its factual cause to trigger the discovery rule for purposes of the statute of limitations instead of also requiring knowledge of negligent treatment, as follows:
That [the plaintiff] has been injured in fact may be unknown or unknowable until the injury manifests itself; and the facts about causation may be in the control of the putative defendant, unavailable to the plaintiff or at least very difficult to obtain. The prospect is not so bleak for a plaintiff in possession of the critical facts that he has been hurt and who has inflicted the injury. He is no longer at the mercy of the latter. There are others who can tell him if he has been wronged, and he need only ask. If he does ask and if the defendant has failed to live up to minimum standards of medical proficiency, the odds are that a competent doctor will so inform the plaintiff.
Id. at 122,
Importantly, the Kubrick case illustrates that the ongoing dispute over the application of the discovery rule to the statute of limitations was limited to the question of whether knowledge that the conduct of the doctor was negligent was needed to trigger the statute of limitations. There was no suggestion that knowledge of an injury, without more, triggered the statute of limitations.
Considering the pervasive national adoption of the discovery rule at the time Iowa enacted its statute, we think our legisla
While we have correctly discerned that the legislature clearly narrowed the discovery rule under the statute to exclude any requirement that a plaintiff discover that the injury was caused by negligence or wrongdoing of the physician, our prior cases have failed to identify the role of factual causation as an element of the statutory discovery rule. As experienced in other jurisdictions from time to time, we have applied the discovery rule literally in terms of “the injury” and have neglected to affirmatively acknowledge the role and necessity of any type of causation in the analysis. Yet, this result is understandable because each time we have considered the statute since its enactment the factual cause of the injury was not at issue. Instead, the factual cause was known or discovered at the time the injury was discovered. In particular, when we stated in Langner that the statute began to run upon discovery of the injury, the plaintiff knew at the time the injury was discovered that it was caused by care provided by the physician.
This view is also supported by our application of inquiry notice to the discovery rule. Inquiry notice plays a role in the medical malpractice statute due to the implied knowledge (“should have known”) component of the statute. This component charges a plaintiff with knowledge of those facts that a reasonable investigation would have disclosed. See Franzen,
If the limitation period to file a lawsuit under the statute is interpreted to commence once plaintiffs gain sufficient information of the injury or physical harm without regard to its cause, some plaintiffs may not know enough to understand the need to seek expert advice about the possibility of a lawsuit to protect themselves from the statute. In some instances, the cause of medical malpractice injuries may be evident from facts of the injury alone, but in other cases it may not. Yet, in all cases, a plaintiff must at least know the cause of the injury resulted or may have resulted from medical care in order to be protected from the consequences of the statute of limitations by seeking expert advice from the medical and legal communities. The fundamental objective of applying the discovery rule to the statute of limitations is to put malpractice plaintiffs on comparable footing as “other tort claimants” to be able to “determine within the period of limitations whether to sue or not.” Id. at 124,
We think it is clear our legislature intended the medical malpractice statute of limitations to commence upon actual or imputed knowledge of both the injury and its cause in fact. Moreover, it is equally clear this twin-faceted triggering event must at least be identified by sufficient facts to put a reasonably diligent plaintiff on notice to investigate.
This approach rejects the claim made by the Rathjes that “the injury” that will trigger the statute can be separated into different degrees of harm or different categories of harm that separately give rise to different triggering dates. The statute does not work in that manner. We adhere to the rule that a plaintiff does not need to know the full extent of the injury before the statute of limitations begins to run. See LeBeau,
The statute begins to run only when the injured party’s actual or imputed knowledge of the injury and its cause reasonably
The general approach we adopt today is consistent with the framework followed in other jurisdictions that apply the discovery rule to statutes of limitation in medical malpractice cases. As previously indicated, nearly all jurisdictions in this country apply some form of the discovery rule to statutes of limitation in medical malpractice cases. David W. Feeder II, When Your Doctor Says, “You Have Nothing to Worry About, ” Don’t Be Sure: The Effect of Fabio v. Bellomo on Medical Malpractice Actions in Minnesota, 78 Minn. L.Rev. 943, 953 (1994). While these jurisdictions reach different conclusions on the question whether discovery of causation involves the relationship between the injury and the'faetual cause or the relationship between the injury and negligence (or some evidence of wrongdoing), they all recognize causation to be an essential component of the analysis. See Bussineau,
We emphasize the knowledge standard under the statute is predicated on actual or imputed knowledge of the facts to support the injury and of the facts to support a cause. See Kubrick,
In applying the medical malpractice statute of limitations, as we now interpret it, to the undisputed facts in this case, it is clear the Rathjes knew Georgia was suffering from physical harm. However, a reasonable jury could find they did not know the cause of the harm until, at the earliest, April 27, 1999, the date the gas-troenterologist made a diagnosis of “drug-induced hepatitis secondary to Antabuse.” Moreover, the jury could find that, until that time, no facts were available that would have alerted a reasonably diligent person that the cause of the injury may have originated in Georgia’s medical treatment so as to put the plaintiffs on notice of the need to investigate. Consequently, a reasonable jury could conclude the Rathjes filed their petition within the two-year limitation of section 614.1(9). The district court erred in granting summary judgment for the defendants.
The approach taken today departs from the direction we have taken in our prior cases since the time the statute was enacted. Yet, it is not necessarily inconsistent with the outcomes of our prior cases. Moreover, it better reflects the objective of the discovery rule to prevent the limitations period from commencing when blameless plaintiffs are unsuspecting of a possible claim.
Finally, if our interpretation of the medical malpractice statute of limitations is out of line with the original intent of the legislature, that body can respond to correct it. We have tried to define the triggering date for the discovery rule with more clarity, and this will allow our legislature to intervene if we have missed the mark. Yet, we firmly believe this interpretation resolves the basic systemic problem that has plagued our prior interpretation of the statute and should allow the statute to work to better achieve its purposes and goals.
IV. Conclusion.
We reverse the decision of the district court and remand the case to the district court for further proceedings.
REVERSED AND REMANDED.
Notes
. We conclude the district court did not abuse its discretion in allowing the hospital and Dr. Schroeder to amend their petitions. See Rife v. D.T. Corner, Inc.,
. All states have enacted a statute of limitations for tort victims and nearly all such statutes require the action to be filed within one to three years of the accrual of the action. David W. Feeder II, When Your Doctor Says, “You Have Nothing to Worry About," Don’t Be Sure: The Effect of Fabio v. Bellomo on Medical Malpractice Actions in Minnesota, 78 Minn. L.Rev. 943, 950 (1994). The vast majority of states, like Iowa, have adopted a two-year limitation period. Id.
. “Like most general rules of law,” the rules "pertaining to 'limitations’ become less than profound when an attempt is made to apply them to specific cases.” Mattingly v. Hopkins,
. Statutory exceptions for actions based on fraud, mistake, and trespass to land remain today and are codified in section 614.4.
. The only issue presented to the district court was whether the defendants were entitled to summary judgment. The plaintiffs did not file a cross-motion for summary judgment. Thus, we are not presented with the question whether the Rathjes filed their petition within the two-year statute of limitations period as a matter of law.
. In all of our prior medical malpractice statute-of-Iimitations cases under section 614.1(9), the factual cause of the injury was known or should have been known at the time the injury was discovered. Thus, the absence of the factual-causation component adopted today from our prior analysis has not been responsible for any unfairness to a blameless, unsuspecting plaintiff. Any claims of past unfairness in the application of the discovery rule to the statute of limitations in medical malpractice cases must be analyzed under the injury component of the rule, a question not at issue in this case.
Concurrence Opinion
(concurring specialty)-
I concur in the legal interpretation by the majority opinion of Iowa Code section
Because a cross-motion for summary judgment on the statute-of-limitations issue was not filed by the plaintiffs, the majority has declined to extend its discussion to consider the adequacy of the record to withstand such a motion. In order to more clearly describe the scope of our ruling and to provide guidance to the district court, I would make it clear that under the current record no reasonable jury could conclude the plaintiffs should have known the injury was caused by medical care prior to the time the treating physician made the connection between the injury and the ingestion of Antabuse. See Hardi v. Mezzanotte,
Nothing in the majority opinion is inconsistent with these observations.