Opinion
No. 3-632 / 02-2051
Filed September 10, 2003
Appeal from the Iowa District Court forPolk County, Eliza Ovrom, Judge.
Plaintiff appeals the district court's grant of summary judgment in favor of defendants in her medical malpractice suit. AFFIRMED.
Jerry Crawford and Jim Quilty of Crawford Law Firm, Des Moines, for appellant.
Kermit Anderson of Finley, Alt, Smith, Scharnberg, Craig, Hilmes Gaffney, P.C., Des Moines, for appellees Yost and Iowa Physicians Clinic.
Roy Irish and Robin Hermann of Patterson, Lorentzen, Duffield, Timmons, Irish, Becker Orway, L.L.P., Des Moines, for appellees Bean and Dermatology, P.C.
Considered by Vogel, P.J., and Mahan and Zimmer, JJ.
The plaintiff appeals the district court's grant of summary judgment in favor of the defendants in her medical malpractice suit. She contends the district court erred when it found her claims to be time barred. Alternatively, she argues the court erred by rejecting her argument that the statute of limitations was tolled by the continuous treatment doctrine and the fraudulent concealment doctrine. We affirm.
Background Facts and Proceedings. On August 2, 1996, Patricia Caswell was seen by Dr. Achille Pandullo, a family practitioner at Integra Health for a rash on the upper half of her body. The rash had persisted for three or four months. Dr. Pandullo referred Caswell to a dermatologist, Dr. Andrew Bean at Dermatology, P.C. Caswell was first seen by Dr. Bean on August 22, 1996. Dr. Bean took a history, conducted an examination, took a biopsy and prescribed medications for her rash. Following Caswell's visit, Dr. Bean wrote a letter to Dr. Pandullo and Dr. William Yost stating her skin eruptions were suspicious of connective tissue disorder, more commonly known as lupus, and that he was starting her on Prednisone. Caswell was told by both Dr. Bean and Dr. Pandullo that she likely had lupus, that there was no cure for lupus, and that she would have good and bad days.
Dr. Yost practiced with Dr. Pandullo at Integra Health; however, he never examined Caswell.
On September 12, 1996, Caswell had a follow-up visit with Dr. Bean. Her rash was better but had not cleared up completely. On September 16, 1996, Dr. Bean wrote a letter to Dr. Yost stating that Caswell's condition could be due to a drug reaction to Dilantin, and "it may be reasonable to switch her over to Tegretol for seizure control if her eruption reappears." Caswell called Dr. Bean's office on September 30, 1996, to inform him that the rash had returned, and he prescribed additional medication. Caswell did not return to see Dr. Bean until September 12, 1997. From September 1996 to September 1997 Caswell's rash worsened, and it became noticeable to other people. She described it as "horrible." In August 1997 the rash covered Caswell's entire body. Her feet were swollen and crusted across the bottom, and her hands bled because her skin was so thin. The rash did not begin to clear up until she stopped taking Dilantin. At her September 1997 appointment, Dr. Bean informed Caswell that he had suspected her rash could be caused by Dilantin, and he showed her the letter he had written to Dr. Yost on September 16, 1996. Until this appointment, Caswell was under the mistaken belief that she had lupus.
On June 21, 1999, Caswell filed a petition naming as defendants Dr. Yost, Iowa Physicians Medical Foundation d/b/a Integra Health and Central Iowa Hospital Corporation. On September 8, 1999, Caswell filed an amended petition naming Dr. Bean and Dermatology, P.C. as defendants. In her petition Caswell alleged defendants were negligent for failing to properly diagnose and treat her skin rash condition. The defendants filed a motion for summary judgment contending Caswell's claims were barred by the two-year statute of limitations in Iowa Code section 614.1(9) (1999). In granting defendants' motion, the district court found Caswell was on inquiry notice by at least Christmas of 1996 that her skin condition was not improving and, thus, her suit was filed outside the applicable limitations period. The court also found nothing in the case to compel the application of the continuous treatment doctrine or the fraudulent concealment doctrine. Caswell appeals.
Dr. Pandullo died in 1997 and is not named as a defendant in this case. Also, Central Iowa Hospital Corporation was dismissed from the case at the summary judgment hearing as all parties agreed there was no employer-employee relationship between the hospital and Dr. Yost.
Standard of Review. We review a summary judgment ruling for corrections of errors of law. Howell v. Merritt Co., 585 N.W.2d 278, 280 (Iowa 1998). Under Iowa Rule of Civil Procedure 1.981, summary judgment is appropriate when no genuine issue of material fact exists and the moving party is entitled to judgment as a matter of law. Id. The facts are reviewed in the light most favorable to the nonmoving party. Shriver v. City of Okoboji, 567 N.W.2d 397, 400 (Iowa 1997).
Statute of Limitations. Personal injury actions against a physician arising out of patient care are subject to a two-year statute of limitations. Iowa Code § 614.1(9). The statute of limitations 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." Langner v. Simpson, 533 N.W.2d 511, 517 (Iowa 1995). The ultimate question is when a plaintiff gained knowledge of her injury sufficient to put her on inquiry notice to investigate further. McClendon v. Beck, 569 N.W.2d 382, 385 (Iowa 1997). On that date, the person is charged with knowledge of facts that would have been disclosed by a reasonably diligent investigation. The statute of limitations continues to run even if the patient is unaware of the physician's negligence. Langner, 533 N.W.2d at 517.
The district court ruled as follows:
There is no dispute here that Caswell had actual knowledge of her claim on September 12, 1997, when she was informed by Dr. Bean that the skin rash was likely caused by Dilantin. She argues that she filed suit against both defendants within two years of that date. Defendants argue she had knowledge of the skin rash, and that it was worsening, as early as Christmas of 1996, and that the statute of limitations ran prior to when she sued Dr. Yost in June 1999, and Dr. Bean in September 1999.
The undisputed facts show that Caswell knew of her injury in late 1996 and early 1997. She saw Dr. Pandullo in August 1996 and saw Dr. Bean twice in September of that year. Although the condition briefly improved for two months in the fall of 1996, it never subsided, and had "gotten bad" by Christmas of that year. In February 1997 the rash was visible to others and described by Caswell as "horrible." In the spring of 1997 the rash was on her face, and the rash continued through the spring and summer of 1997.
The Court concludes Caswell was on inquiry notice by at least Christmas of 1996 that her skin condition was not improving. By February 1997 the rash was "horrible." It worsened during the spring of 1997. Caswell did not take any steps at that time to inquire with her doctors about the rash. She did not file suit within two years of the time she should have known, through the exercise of reasonable diligence, of her injury. Thus the claims are barred under Iowa Code section 614.1(9).
Caswell contends the district court misinterpreted what constituted her injury and thus, incorrectly determined the date she knew of her injury. Caswell argues her injury did not occur on the day she became aware of the rash. Rather, her injury was the needless persistence of the original rash due to the defendants' negligence and, therefore, she could not have known of her injury until September 12, 1997, when she was made aware that Dilantin was causing her rash to persist. Based on our review of the undisputed facts in the record, we conclude the district court properly found Caswell was placed on the requisite inquiry notice by Christmas of 1996. We note Caswell did not know medically why her rash was persisting. However, the law does not require such knowledge: the law only requires that she be aware that a problem exists. See id.at 518. This result, at first glance, may appear to be unjust or unfair. Caswell, however, after seeing Dr. Bean on August 22, 1996, and September 12, 1996, and talking to him on September 30, 1996, did not return to see him until September 12, 1997. This was true even though the rash was "horrible," noticeable to other people, and was affecting her entire body. We agree with the district court that Caswell did not take any steps to inquire about the worsening nature of the rash during this time lag. We conclude Caswell was charged with knowledge of the facts that would have been disclosed by a reasonably diligent investigation. Langner, 533 N.W.2d at 517. We therefore affirm the district court's determination that Caswell did not file her suit within the two-year limitations period and, thus, her claims are barred.
Continuous Treatment Doctrine. Caswell contends that this court should adopt the continuous treatment doctrine. Our supreme court has considered the application of this doctrine on at least two occasions but has yet to decide whether it tolls the statute of limitations in section 614.1(9) because the court found the doctrine inapplicable in both cases. See McClendon,569 N.W.2d at 385; Langner, 533 N.W.2d at 519. After a careful review of the summary judgment record, we decline to decide whether Iowa should adopt the continuous treatment doctrine because we find it does not apply to the facts in this case.
Fraudulent Concealment. Caswell alleges that defendants fraudulently concealed from her that Dilantin was causing her rash to persist. Fraudulent concealment may be shown if the plaintiff proves: (1) that the defendant affirmatively concealed the facts on which the plaintiff would predicate the cause of action; or (2) a confidential or fiduciary relationship existing between the person concealing the cause of action and the aggrieved party combined with proof that defendant breached the duty of disclosure. McClendon, 569 N.W.2d at 385. The alleged acts of concealment must be independent of the alleged act ruled on to establish liability. Id. The district court concluded, and we agree, that Caswell's fraudulent concealment claim is based on the same act as her medical malpractice claim-the defendants' failure to disclose what caused her rash. Therefore, we reject Caswell's argument that the doctrine of fraudulent concealment is applicable to the facts in this case and thus tolls the statute of limitations.
Accordingly, we affirm the decision of the district court.