Case Title: Sandra and Mark Brinkman v. Anne P. Bueter, M.D., James F. Dupler, M.D., and Women's Health Partnership, P.C.

Citation: 

Docket Number: 29S02-0704-CV-141

State: indiana

Court: Indiana Supreme Court

Date: 2008-01-15T00:00:00Z

Document:
ATTORNEYS FOR APPELLANTS 
 
 
 
 
ATTORNEYS FOR APPELLEES 
Rex E. Baker 
Mary H. Watts 
Caroline A. Gilchrist 
Nana Quay-Smith 
Avon, Indiana 
Kelly R. Eskew 
 
Indianapolis, Indiana 
 
 
In the 
Indiana Supreme Court  
_________________________________ 
 
No. 29S02-0704-CV-141 
 
SANDRA AND MARK BRINKMAN, 
Appellants (Plaintiffs Below), 
 
v. 
 
ANNE P. BUETER, M.D., 
JAMES F. DUPLER, M.D., AND 
WOMEN’S HEALTH PARTNERSHIP, P.C., 
Appellees (Defendants Below). 
_________________________________ 
 
Appeal from the Hamilton Superior Court, No. 29D01-0410-CT-872 
The Honorable Steven David, Special Judge 
_________________________________ 
 
On Petition to Transfer from the Indiana Court of Appeals, No. 29A02-0510-CV-980 
_________________________________ 
 
January 15, 2008 
 
Shepard, Chief Justice. 
Patients waited until 2000 to file their medical malpractice complaint even though all 
underlying events occurred in 1995.  Nothing prevented them from filing a complaint within the 
statutory period, and the defendant medical providers are thus entitled to summary judgment 
under Indiana’s Medical Malpractice Act.   
 
 
FILED
CLERK
of the supreme court,
court of appeals and
tax court
Jan 15 2008, 11:26 am
Facts and Procedural History 
 
Sandra Brinkman learned she was pregnant in May 1994, and she was due to deliver in 
February 1995.  Dr. Anne Bueter was her primary obstetrician, but all of the physicians at 
Women’s Health Partnership, P.C. (“WHP”) saw Mrs. Brinkman during her pregnancy.   
 
Dr. James Dupler saw Mrs. Brinkman on January 19, 1995, at 38 weeks, and noted that 
her urine was positive for two plus protein, that she had increased blood pressure, and that she 
had gained 2.8 pounds in one week.  He instructed her to come back in three days instead of a 
week, possibly considering a diagnosis of preeclampsia.1   
 
Three days later, on January 22, 1995, Mrs. Brinkman was admitted to St. Vincent 
Hospital.  She complained of severe headaches, “unlike any headache in the past,” spots in front 
of her eyes, epigastric pain, and vomiting.  (App. at 41-42.)  The admitting nurse also found 
slight swelling in Mrs. Brinkman’s hands and ankles.  Dr. Dupler was on-call, and he 
documented Mrs. Brinkman’s increased blood pressure and trace protein, but found no swelling, 
no neurological signs, no photophobia, and no visual changes.  He concluded she displayed “no 
preEclamptic signs or symptoms.”  (Id. at 42.)   
 
Because Dr. Dupler could not identify the etiology of the headaches, he ordered a 
neurological exam by Dr. Wesley Wong, but the exam did not produce any explanation for the 
headaches.  Dr. Wong also ruled out preeclampsia.    
                                             
 
1 Preeclampsia, a condition pregnant women are susceptible to, is marked by three important signs: 
hypertension (high blood pressure), edema (fluid retention), and proteinuria (protein in the urine).   
 
These tend to develop without outward signs or warnings, making early and regular 
prenatal care important to early detection.  If symptoms have developed—headache, 
visual disturbances, epigastric pain—the condition may be in an advanced state.  Prenatal 
visits should include a blood pressure measurement, evaluation of weight gain (about one 
pound per week is normal; more than two pounds per week or six pounds per month is 
reason to suspect incipient preeclampsia), urinalysis for protein, and questions about the 
presence of headaches, pain or visual problems.   
 
Preeclampsia, when present, develops after the twentieth week of pregnancy.  Russ et. al., Attorneys 
Medical Advisor § 14:58-14:59, Binder 1 (Thomson/West 2005).   
 
 
 
2
 
Mrs. Brinkman delivered a healthy baby girl without complication on January 26, 1995.  
Her headaches improved after delivery.  She subsequently developed neck pain on January 27, 
but Doctors Dupler and Wong agreed that it was likely musculoskeletal in origin.2  That same 
evening, Mrs. Brinkman’s neck pain improved, and she “strongly desired to be discharged from 
the hospital.”  (App. at 50.)  She was discharged on Friday, January 27 with “strict instructions to 
call should her headache redevelop or [should] she begin[] having neurological signs or 
symptoms.”  (Id. at 50-51.) 
 
Over the January 28-29 weekend, Mr. Brinkman called WHP both days to report that his 
wife’s headache had redeveloped.  WHP advised that the headache was likely a “sinus headache” 
and recommended Tylenol and Sudafed.  On Monday, January 30, 1995, Mr. Brinkman again 
called WHP to report that she had nausea and vomiting in addition to the headache and that 
Tylenol and Sudafed had not provided any relief.  A nurse called back to say she had spoken 
with a doctor and it was likely a virus or sinus problem.  She recommended that Mrs. Brinkman 
see a family doctor and referred the Brinkmans to Dr. Steven Lang, who Mrs. Brinkman saw the 
same day.   
 
Dr. Lang prescribed medications for pain and nausea, and Mr. Brinkman dropped his wife 
off at home while he went to fill her prescriptions.  When he returned, he found Mrs. Brinkman 
in bed having a seizure.  She was rushed to the hospital by ambulance.  Mrs. Brinkman had 
another seizure in the emergency room, and her blood pressure was 220/120.  During this second 
hospital stay, Mrs. Brinkman was diagnosed with eclampsia and successfully treated for it.3   
 
On March 10, 1995, the Brinkmans went to see Dr. Bueter for Mrs. Brinkman’s post-
partum exam.  Dr. Bueter discussed preeclampsia and eclampsia with the Brinkmans and 
                                             
 
2 Aside from her neck pain, Dr. Wong also expressed concern on January 27, 1995, about Mrs. 
Brinkman’s elevated blood pressure of 153/106.  He noted that he would keep Mrs. Brinkman 
hospitalized until her blood pressure stabilized and her neck pain was resolved.  (App. at 45.) 
3 “If preeclampsia is not treated, it may evolve into a more serious condition called ‘eclampsia,’ 
characterized by convulsions.  This condition is one of the most dangerous in obstetrical practice. . . .   
Several convulsions may follow the first, with coma usually following the series of convulsions.” Russ et. 
al., Attorneys Medical Advisor § 14:60, Binder 1 (Thomson/West 2005). 
 
 
3
explained that Mrs. Brinkman had an atypical case in that she did not show signs of preeclampsia 
until four days after delivery.  (Appellants’ Br. at 12.)  She also counseled that any future 
pregnancy would be high risk, putting Mrs. Brinkman’s life in danger, and discussed sterilization 
options with the Brinkmans.  (App. at 36-37.)  
 
The Brinkmans wanted more children, but they feared for Mrs. Brinkman’s life.  
Although they chose not to proceed with sterilization, they used birth control.  In January 2000, 
Mrs. Brinkman accidentally became pregnant.  She first called WHP to speak with Dr. Bueter, 
but she no longer worked for WHP.  After reviewing her chart, WHP advised Mrs. Brinkman to 
seek high-risk obstetrical care.    
 
The Brinkmans met with Dr. Dawn Zimmer on January 31, 2000.  At this appointment, 
Dr. Zimmer told them: 
1. Sandy had symptoms of preeclampsia that had not received proper care in the 
proper time by Dr. Bueter, Dr. Dupler and Women’s Health Partnership, 
which then progressed to a life threatening situation. 
2. The information given by Dr. Bueter was not correct and that there are 
numerous ways to treat preeclampsia and prevent preeclampsia from 
developing into eclampsia with seizure. 
3. Furthermore, Dr. Bueter’s advice to get sterilized due to the risk to Sandy and 
risks relating to future pregnancies was incorrect.  The risk of preeclampsia 
does not increase in subsequent pregnancies with the same father, 
preeclampsia does not always occur in the subsequent pregnancy and if it 
does, it can be treated. 
(Id.; see also App. at 37.) 
 
Based on this information, the Brinkmans filed a medical malpractice complaint with the 
Indiana Department of Insurance on December 7, 2000.  Despite defendants’ argument that any 
proposed claim was barred by the statute of limitations, the parties proceeded through the 
medical review panel process.4  The panel issued its decision on July 16, 2004,5 and the 
                                             
 
4 Defendants sought a preliminary determination of law that the claims were barred by the statute of 
limitations.  Defendants’ motion was denied, and they appealed.  The Court of Appeals held in Bueter v. 
Brinkman, 776 N.E.2d 910, 913 (Ind. Ct. App. 2002), that the order denying the preliminary 
 
 
4
Brinkmans filed their complaint with the Hamilton Superior Court on October 4, 2004, alleging 
Dr. Bueter, Dr. Dupler, and WHP committed the following negligent acts and/or omissions: 
a. 
The Defendants failed to identify and treat the prenatal signs of preeclampsia 
exhibited by the Plaintiff, Sandra Brinkman; 
b. 
The Defendants failed to identify and treat the continuing signs of eclampsia 
exhibited by the Plaintiff, Sandra Brinkman after delivery and negligently 
discharged her from the hospital on January 27, 1995; 
c. 
The Defendants failed to diagnose and treat the signs of eclampsia reported 
by the Plaintiff, Sandra Brinkman after her discharge from the hospital; and 
d. 
The Defendants failed to appropriately counsel the Plaintiffs, Sandra 
Brinkman and Mark Brinkman about the potential risks and complications 
relating to future pregnancies.   
(Id. at 22-23.) 
 
The defendants moved for summary judgment, arguing that the claims were barred by the 
statute of limitations.  The trial court granted defendants summary judgment on all issues except 
whether Dr. Bueter and WHP negligently counseled the Brinkmans as to the risk of eclampsia in 
future pregnancies.  Both parties appealed, and a divided Court of Appeals reversed the grant of 
summary judgment to the defendants, concluding the medical malpractice statute was 
unconstitutional as applied to the Brinkmans.  It affirmed the denial of summary judgment on the 
issue of negligent counseling.  Brinkman v. Bueter, 856 N.E.2d 1231, 1242 (Ind. Ct. App. 2006).  
We granted transfer. 
 
                                                                                                                                                 
 
determination of law was not a final judgment, and defendants could raise the statute of limitations as an 
affirmative defense after the panel reached its decision.   
5 The panel opinion read:  
The panel is of the unanimous opinion that the evidence does not support the conclusion 
that James F. Dupler, M.D. failed to meet the applicable standard of care.  With regard to 
defendant, Anne P. Bueter, M.D., the panel is of the unanimous opinion that there is a 
material issue of fact, not requiring expert opinion, bearing on liability for consideration 
by the court or jury.  The panel also is of the unanimous opinion that the evidence 
supports the conclusion that defendant, Women’s Health Partnership, failed to comply 
with the appropriate standard of care, and that its conduct was a factor of the resultant 
damages. 
(App. at 18.) 
 
 
5
 
I. 
Statute of Limitations 
The statute of limitations for medical malpractice claimants provides: 
A claim, whether in contract or tort, may not be brought against a health care 
provider based upon professional services or health care that was provided or that 
should have been provided unless the claim is filed within two (2) years after the 
date of the alleged act, omission, or neglect . . . . 
Ind. Code Ann. § 34-18-7-1(b) (West 2007).  This is an “occurrence” statute as opposed to a 
“discovery” statute.  The time therefore begins to run on the date the alleged negligent act 
occurred, not on the date it was discovered.  Martin v. Richey, 711 N.E.2d 1273, 1278 (Ind. 
1999) (citing Cacdac v. Hiland, 561 N.E.2d 758 (Ind. 1990)).   
 
We have upheld the facial constitutionality of this statute multiple times,6 but we have 
also held that it may be unconstitutional as applied to a particular plaintiff.  In Martin, for 
example, the asserted negligence was a physician’s failure to diagnose and treat plaintiff’s breast 
cancer.  All of the physician’s alleged negligent acts occurred in 1991, but the plaintiff did not 
discover that she had breast cancer until 1994.  Thus, while the plaintiff did not file the claim 
within the two-year statutory period, we concluded the statute of limitations was unconstitutional 
as applied, under the Privileges and Immunities Clause and the Open Courts Clause of the 
Indiana Constitution, saying: 
We find the statute of limitations as applied to the plaintiff in this case is 
unconstitutional under [the Privileges and Immunities Clause] because it is not 
“uniformly applicable” to all medical malpractice victims . . . .  Simply put, the 
statute precludes [plaintiff] from pursuing a claim against her doctor because she 
has a disease which has a long latency period and which may not manifest 
significant pain or symptoms until several years after the asserted malpractice.  
The statute of limitations is also unconstitutional under [the Open Courts Clause] 
because it requires plaintiff to file a claim before she is able to discover the 
alleged malpractice and her resulting injury, and therefore, it imposes an 
impossible condition on her access to the courts and pursuit of her tort remedy. 
Id.  at 1279.   
 
                                             
 
6 See Martin, 711 N.E.2d at 1279 (citing Rohrabaugh v. Wagoner, 274 Ind. 661, 413 N.E.2d 891 (1980); 
Johnson v. St. Vincent Hosp., Inc., 273 Ind. 374, 404 N.E.2d 585 (1980)). 
 
 
6
In the companion case of Van Dusen v. Stotts, 712 N.E.2d 491 (Ind. 1999), the plaintiff 
alleged his physicians failed to timely diagnose and treat his prostate cancer.  Stotts first sought 
medical advice in 1992.  Although his physician found a small tumor and performed a biopsy, 
plaintiff was told the tissue was benign.  It was not until Thanksgiving of 1994, more than two 
years after the biopsy, that Stotts experienced any further symptoms.  Stotts was subsequently 
diagnosed with prostate cancer in 1995.  Tailoring a narrow exception based on the plaintiffs in 
Martin and Van Dusen, we said, 
We construe section 34-18-7-1(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 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 . . . . 
Id. at 497 (emphasis added).   
 
For plaintiffs like those in Martin and Van Dusen, the statutory period does not begin to 
run until either the correct diagnosis is made or the patient has sufficient facts to make it possible 
to discover the alleged injury.  See Martin, 711 N.E.2d at 1284-85 (plaintiff unable to claim 
failure to diagnose cancer before plaintiff discovered she in fact had a malignancy); Van Dusen, 
712 N.E.2d at 495 (two-year period triggered on failure to diagnose claim when physician told 
Stotts he had incurable cancer).  As we said in Martin, to hold otherwise “would impose an 
impossible condition on [Martin’s] access to the courts and pursuit of a tort remedy. . . .  [I]t 
would require her to file a claim before such claim existed.”  711 N.E.2d at 1285. 
 
As Justice Selby wrote in Martin, we defer to the legislature’s judgment in enacting an 
occurrence statute and recognize the “legitimate legislative goal of maintaining sufficient 
medical treatment and controlling medical malpractice insurance costs.”  Id. at 1280.  Thus, the 
statutory period runs from the date of the occurrence of the alleged negligent act, except in those 
limited situations where it is impossible for plaintiffs to discover the alleged malpractice.   
 
 
 
 
7
II. 
Application of “Occurrence” Statute 
Three of the Brinkmans’ four claims concern an alleged failure to diagnose and treat 
either preeclampsia or eclampsia.  The fourth claim concerns the post-partum counseling the 
Brinkmans received on March 10, 1995.    
 
Although Mrs. Brinkman was correctly diagnosed with and treated for eclampsia upon 
her January 30, 1995, admission to the hospital, she did not file a complaint until December 
2000.  Because the alleged malpractice occurred in 1995, the complaint obviously fell outside the 
two-year statutory period.   
 
Likening their case to the plaintiffs in Martin and Van Dusen, the Brinkmans argue that 
the statute is unconstitutional as applied to them.  (Appellants’ Br. at 19, 23-27.)  Unlike the 
plaintiffs in Martin and Van Dusen, however, Mrs. Brinkman did not suffer from a disease or 
medical condition with a long latency period.  When a physician fails to diagnose cancer, the 
patient may continue without symptoms for years.  It is impossible for these patients to claim 
failure to diagnose cancer before they know they are suffering from the disease.  The Brinkmans 
did not face this challenge.  Instead, Mrs. Brinkman suffered eclamptic seizures on January 30, 
1995, and was immediately diagnosed with and treated for eclampsia.7  All of these events 
occurred in 1995, and nothing prevented the Brinkmans from bringing a claim about faulty 
diagnosis or treatment within the two-year statutory period.  The statute of limitations on the 
Brinkmans’ failure to diagnose and treat claims thus began to run in 1995 and expired in 1997.  
The trial court was correct to grant summary judgment to defendants on these claims. 
 
                                             
 
7 The Court of Appeals emphasized the distinction between preeclampsia and eclampsia, emphasizing that 
Mrs. Brinkman was never diagnosed with preeclampsia.  Brinkman, 856 N.E.2d at 1238-39.  This 
distinction is irrelevant for two reasons.  First, Dr. Bueter discussed both preeclampsia and eclampsia with 
the Brinkmans at the post-partum exam in 1995.  (Appellants’ Br. at 12.)  Second, preeclampsia is simply 
a precursor to eclampsia.  See Russ et. Al., Attorneys Medical Advisor § 14:60, Binder 1 (Thomson/West 
2005) (“If preeclampsia is not treated it may evolve into a more serious condition called ‘eclampsia.’”); 
see also Stedman’s Medical Dictionary 609 (28th ed., Lippincott Williams & Wilkins 2006) (defining 
eclampsia as “Occurrence of one or more convulsions, not attributable to other cerebral conditions such as 
epilepsy or cerebral hemorrhage, in a patient with preeclampsia.”).  The diagnosis of eclampsia thus 
triggered the statute of limitations for the failure to diagnose preeclampsia claim.   
 
 
8
 
 
9
The Brinkmans similarly argue that they did not have sufficient facts to support their 
negligent counseling claim until 2000, when Dr. Zimmer contradicted some of the advice given 
to them at the 1995 post-partum exam.  This argument lacks merit.  A plaintiff does not need to 
be told malpractice occurred to trigger the statute of limitations.  Van Dusen, 712 N.E.2d at 499.  
The Brinkmans were equipped with a correct diagnosis in 1995, and the alleged negligent 
counseling occurred in 1995.  Nothing prevented the Brinkmans from seeking further medical or 
legal advice.  Thus, the two-year statute of limitations also bars this claim. 
 
 
Conclusion 
 
We affirm the trial court’s grant of summary judgment to the defendants and direct entry 
of judgment on the counseling claim. 
 
Dickson, Sullivan, Boehm, and Rucker, JJ., concur.