Lead Opinion
This case and two other eases currently pending before this Court address the constitutionality of the two-year medical malpractice statute of limitations contained in Indiana Code section 34-18-7-1 (b) (1998) (repealing section 27-12-7-l(b) (1993)). In each of these cases, plaintiffs challenge the constitutionality of the statute of limitations under the Open Courts Clause of Article I, Section 12 and the Privileges and Immunities Clause of Article I, Section 23 of the Indiana Constitution.
In Martin v. Richey,
As we discuss more fully below, plaintiff and appellee below, William H. Stotts (“Stotts”), like the plaintiff in Martin, suffered from cancer and was unaware that he had cancer and that it had spread to his lymph nodes until more than two years following the alleged negligent act. He also had no information that, in the exercise of reasonable diligence, should have led to the discovery of the alleged malpractice and his resulting condition during the statutory period. Given these undisputed facts, and consistent with our holdings in Martin, we agree with the trial court that the two-year occurrence-based medical malpractice statute of limitations may not constitutionally be applied to Stotts.
Our decision on this point does not completely dispose of this appeal, however, because this case also requires us to determine how generally to construe or reconstrue the statute of limitations to avoid its unconstitutional application in this case and in future cases. Then we must apply the statute, as we have construed it, to the specific facts here.
We conclude that section 34-18-7-l(b) permits plaintiffs like Martin and the Stottses to file their claims within two years of the date when they discover the malpractice and the resulting injury or facts that, in the exercise of reasonable diligence, should lead to the discovery of the malpractice and the resulting injury. We also conclude that in this
Accordingly, we affirm the trial court’s decision granting summary judgment for plaintiffs and denying defendants’ motion. We remand for further proceedings not inconsistent with this opinion.
FACTS AND PROCEDURAL BACKGROUND
The facts in this case are undisputed. William H. Stotts went to his family doctor in June of 1992 because he had a head cold, and, while he was there, his doctor did a routine examination of his prostate. Because his doctor thought that his prostate felt somewhat abnormal, he did a PSA blood test, and the blood test showed an elevation that might indicate that Stotts had prostate cancer. Although Stotts had no other symptoms of prostate cancer, his doctor referred Stotts to Dr. Robert Allen, a urologist, for a followup evaluation and Dr. Alen examined Stotts in July 1992. He found a very small tumor, performed a needle biopsy on the tumor, and sent the sample to the Columbus Regional Hospital Pathology Department (“hospital”) to determine whether the cells were malignant.
Appellant Dr. Delbert Van Dusen and appellant Dr. David O’Brien, who, together with the hospital, were defendants below (“defendants”), read the biopsy. In a report dated July 24, 1992, Dr. Van Dusen noted that, although there were some cells that were mildly atypical, the tissue was benign. On July 27, 1992, Dr. O’Brien confirmed Dr. Van Dusen’s diagnosis that the tissue was benign. Dr. Alen relied on this diagnosis, and his office informed Stotts and his wife that the biopsy results showed no cancer. Stotts was relieved.
Aound Thanksgiving of 1994, Stotts experienced pain and swelling in his groin area and his lower back. When pain medication and ice packs did not eliminate his pain or relieve the swelling, Stotts’s doctor, who suspected a lumbar strain, referred him for a CT scan and ordered another PSA blood test. The CT scan showed an abnormality and the PSA blood levels were high. A follow-up bone scan suggested that metastasis was a possibility. Stotts’s doctor then referred him again to Dr. Alen in January of 1995. Ater reviewing all of his tests and examining Stotts, Dr. Alen concluded that Stotts had metastatic disease; that the metastatic disease was the result of his prostate tumor, which previously had been reported as noncancerous; and that the cancer had spread to his lymph nodes and bones. Dr. Alen informed Stotts that he had incurable prostate cancer.
At the time Dr. Alen diagnosed his prostate cancer on or about January 25, 1995, Stotts and his wife inquired as to whether the initial biopsy in 1992 was improperly read, and Dr. Alen stated that this was a possibility.
Dr. Alen treated Stotts with monthly injections until he became too sick to work and lost his health insurance. When Stotts could no longer afford the monthly injections, he opted for the one-time expense of surgical castration, which occurred in March of 1995. For a while his cancer was isolated, but by December 1995, his cancer had begun to spread again.
In January of 1996, Stotts’s urologist had the 1992 biopsy reread by a pathologist at the hospital, and that pathologist read the biopsy as malignant. In February of 1996, Dr. Alen informed Stotts that he likely had three to six months to live. Dr. Alen also informed Stotts that he had had the 1992 biopsy slides reread, that they showed a malignancy, and that they had been badly misread in 1992.
Two months later, on April 3, 1996, Stotts and his wife filed a complaint alleging negligence with the Indiana Department of Insurance. That complaint named Columbus Regional Hospital and “Dr. X” as defendants. Thereafter they filed several amended complaints. On April 10, 1996, they filed a second amended complaint in which Dr. Van Dusen was first named as a defendant, and, on July 30,1996, they filed a fourth amended
On September 19,1996, the Stottses filed a complaint for declaratory judgment requesting that the court declare the two-year medical malpractice statute of limitations, Indiana Code section 34-18-7-l(b), unconstitutional on its face under Article I, Section 12 and Article 1, Section 23 of the Indiana Constitution. Defendants moved for a preliminary determination of law and summary judgment on the statute of limitations question, and plaintiffs opposed defendants’ motion for summary judgment and also moved for summary judgment in their favor.
After holding a hearing on the cross-motions for summary judgment, the trial court granted the Stottses’ motion for summary judgment. Specifically, the court held that the two-year occurrence-based statute of limitations was unconstitutional as applied to the facts of the case upon which there is no genuine issue of material fact. The court reasoned that the undisputed evidence establishes that “plaintiffs did not and could not have known, discovered or ascertained, even with the use of reasonable care, that the cancer, which was allegedly misdiagnosed on July 14, 1992, existed during the limitations period provided by Ind. Code § 27-12-7-1.” (R. at 279-80.) The court emphasized that “a statute of limitations cannot run and expire before the injured party has any way to discover or ascertain that he has been injured or that a tort has occurred.” (R. at 280.)
Defendants challenge the decision below. This Court has jurisdiction pursuant to Indiana Appellate Rule 4(A)(8), which grants this Court the authority to directly review a case in which an Indiana statute has been declared unconstitutional.
DISCUSSION
The trial court correctly concluded that the two-year medical malpractice statute of limitations, section 34-18-7-1 (b), as previously construed, is unconstitutional as applied to plaintiffs. The trial court, however, did not address how that statute might be construed or reeonstrued to avoid its unconstitutional application in this case or future cases. We do so today and then apply the statute, as so construed, to the facts of this case.
In Part I, we conclude that section 34-18-7-l(b) should be construed to permit plaintiffs like Martin and the Stottses to file their claims within two years of the date when they discover the malpractice and the resulting injury or facts that, in the exercise of reasonable diligence, should lead to the discovery of the malpractice and the resulting injury. In Part II, we apply this general rule and conclude that, in this case, the two-year period was triggered when, in January of 1995, Dr. Allen informed Stotts that he had incurable cancer and that the biopsy slides may have been misread in 1992. Plaintiffs’ claim of medical malpractice, therefore, was timely filed within the two-year statutory period.
I.
Defendants argue essentially that, if this Court concludes that the statute is unconstitutional, then there is no legal statutory time period applicable to plaintiff. Defendants assert that this Court should not usurp legislative authority by simply creating one and at the same time urge this Court to allow plaintiffs only a reasonable period of time from discovery to file suit as it would in a case involving the equitable doctrine of fraudulent concealment. In that context, this Court has held that a plaintiff who invokes the doctrine of fraudulent concealment does not have two full years from the discovery of the alleged malpractice in which to file a claim. See Hughes v. Glaese,
Defendants further argue that the medical malpractice statute of limitations should be construed as requiring plaintiff to file a medical malpractice claim within a reasonable period of time after discovering the malpractice and, citing Spoljaric v. Pangan,
We cannot' accept defendants’ argument because, as plaintiffs point out, they have not raised the equitable doctrine of fraudulent concealment. More importantly, however, defendants’ argument is based on the erroneous assumption that, if we conclude that the trial court improperly granted summary judgment for defendants, we will strike the statute down as unconstitutional on its face. We, however, determined in Martin that the statute is not unconstitutional on its face and have declared only that certain applications are unconstitutional. We, therefore, need not resort to equity to establish constraints upon the filing of medical malpractice claims by a plaintiff such as Stotts.
Rather than simply ignoring the statute of limitations and its two-year time period, as defendants would have us do, the better course is to construe or reconstrue the statute in such a way as to further the purposes of the legislature without offending the Indiana Constitution. To the extent that the legislature intended to create a statute of limitations that always runs from the date of the occurrence of the alleged negligent act, even when the malpractice and resulting injury cannot be discovered during the limitations period given the nature of the asserted malpractice and the medical condition, then, of course, we cannot effectuate this particular legislative intent without doing violence to the Indiana Constitution.
Even if defendants’ proposed approach were not more fundamentally flawed, we must reject it because it does not further effectively the legislature’s general purpose. The “reasonable” time frame defendants have proposed is not only inconsistent with the language of the statutory provision which
Our task of finding a construction of section 34-18-7-l(b) which utilizes the two-year period established by the legislature and furthers the general legislative goals without running afoul of the state constitution, is aided by reviewing general rules we have utilized in other similar contexts.
While we have rejected defendants’ argument that plaintiffs should have a “reasonable time” from discovery to file their claims, as in fraudulent concealment cases, we do find that those eases provide useful guidance in determining what date triggers the running of the two-year statutory period. When plaintiffs have asserted active fraudulent concealment in the medical malpractice context, this Court has held that the reasonable time period allowed for filing suit begins to run when “a plaintiff discovers the alleged malpractice or discovers information which in the exercise of reasonable diligence would lead to the discovery of the malpractice.” See Hospital Corp. of America, 547 N.E.2d. at 874-75.
We have utilized similar general rules in cases construing the statute of limitations applicable to other tort and product liability cases, Indiana Code sections 34-1-2-2 (general tort) and 33-1-1.5-5 (product liability) (1998). See Wehling v. Citizens Nat’l Bank,
We now fashion a similar rule of construction here. We construe section 34-18-7-l(b) to permit plaintiffs like Martin and the Stottses — that is, plaintiffs who, because they suffer from cancer or other similar diseases or medical conditions with long latency periods and are unable to discover the malpractice and their resulting injury within the two-year statutory period — to file their claims within two years of the date when they discover the malpractice and the resulting injury or facts that, in the exercise of reasonable diligence, should lead to the discovery of the malpractice and the resulting injury.
II.
Having construed section 34-18-7-1(b) and formulated the general rule for triggering the running of its two-year statutory period, we now apply the general rule here to determine the date on which plaintiff discovered the malpractice and his resulting injury, or facts that should have led to the discovery of the malpractice and his resulting injury.
Defendants suggest that discovery occurred in January of 1995, when Dr. Allen informed Stotts that he had terminal cancer and that the initial biopsy slides may have been misread in 1992. Plaintiffs, however, suggest that discovery did not occur until February of 1996, when Dr. Allen informed him that those biopsy slides, in fact, were badly misread. Because we have determined that a plaintiff has two years from discovery to file a medical malpractice claim, and because plaintiffs filed complaints against the defendant hospital and defendant Van Dusen in April and defendant O’Brien in July of 1996, plaintiffs have timely filed their complaint regardless of whether the triggering date is in January of 1995 or February of 1996. Nevertheless, because the rule we announce today may become especially important in other cases, we complete our analysis of the application of the rule to the facts in
In determining what date constitutes discovery within the meaning of the rule we announce today, we again look to Indiana cases which have construed the general tort liability and the product liability statutes of limitation. Three of these cases are particularly helpful to our analysis because they highlight the difference between actual knowledge of malpractice and knowledge of facts that, in the exercise of reasonable diligence, should lead to the discovery of the malpractice, and because they shed light on the kind of facts that, in the exercise of reasonable diligence, should lead to the discovery of the medical malpractice as well as the resulting injury.
In Evenson v. Osmose Wood Preserving Co. of America,
In Evenson, the Seventh Circuit, applying Indiana’s product liability statute of limitations, reasoned that a person knows or should have discovered the cause of his injury when he has or should have discovered some evidence that there was a “reasonable possibility” that his injury was caused by the act or product of another. Id. at 705. The Seventh Circuit emphasized that, while events short of a doctor’s firm diagnosis can provide a plaintiff with evidence of á reasonable possibility that another’s act or product caused his injuries sufficient to trigger the running of the two-year statutory period, there must be something more than the mere suspicion or speculation by a plaintiff who is without technical or medical knowledge. Id. The court concluded that plaintiff’s mere suspicions regarding the cause of her medical problems in February of 1985 did not trigger the time period, and that plaintiffs suit was not time barred. Id.
In Allied Resin Corp. v. Waltz,
Most recently, in Degussa Corp. v. Mullens,
In Degussa, the Court of Appeals rejected plaintiff’s argument that the two-year statute of limitations did not begin to run until March of 1994 when she learned with certainty that her illness was related to her exposure to the chemicals, and concluded that the statute began to run when her doctor informed her of the possible causal link and the need to investigate further. The Court of Appeals reasoned that it was at that point that she should have discovered the causal link, and that it was not necessary that she know with certainty that the chemicals at work were causing her illness. Id. at 178.
Informed by this line of cases, we conclude that under the rule we fashion today, the question of when a plaintiff discovered facts which, in the exercise of reasonable diligence, should lead to the discovery of the medical malpractice and resulting injury, is often a question of fact. See, e.g., Burks,
An application of the rule here warrants a conclusion that the two-year period for filing a malpractice claim was triggered in January of 1995 and not in February of 1996. It was in February of 1996 that Dr. Allen informed plaintiffs that the 1992 biopsy slides, which he arranged to be reread in January of 1996, were badly misread, and that Stotts had
Athough we have rejected plaintiffs’ suggested trigger date, their claim nevertheless was timely filed as a matter of law because plaintiffs filed their complaints in April and July of 1996, within two years of January 25, 1995 when they discovered that Stotts had incurable prostate cancer and that the 1992 biopsy slides may have been misread.
CONCLUSION '
Accordingly, we affirm the decision below granting plaintiffs’ motion for summary judgment and denying defendants’ motion. We remand for further proceedings not inconsis-tént with this opinion.
Notes
. See Martin v. Richey,
. This Court has never adopted Spoljaric v. Pangan,
. See Toth v. Lenk,
Concurrence Opinion
concurring.
While I did not join the decision today in Martin v. Richey,
