Case Title: Greene v. Legacy Emanuel Hospital

Citation: 

Docket Number: S47406

State: oregon

Court: Oregon Supreme Court

Date: 2002-12-27T00:00:00Z

Document:
FILED:  December 27, 2002
IN THE SUPREME COURT OF THE STATE OF OREGON
BOBBIE J. GREENE,
Petitioner on Review,
	v.
LEGACY EMANUEL HOSPITAL AND HEALTH CARE CENTER,
an Oregon corporation,
Defendant,
	and
CHERYL L. NESLER, M.D.,
Respondent on Review.
(CC 9707-05788; CA A102423; SC S47406)
	On review from the Court of Appeals.*
	Argued and submitted January 4, 2001.
	J. Michael Alexander, Swanson, Lathen, Alexander & McCann,
PC, Salem, argued the cause and filed the briefs for petitioner
on review.
	Nancy S. Tauman, Hibbard Caldwell Schultz Ramis & Crew,
Oregon City, argued the cause and filed the brief for respondent
on review.  With her on the brief was Nelson L. Walker.
	Thomas M. Christ, Mitchell, Lang & Smith, Portland, argued the cause and filed a
brief on behalf of amicus curiae Oregon Association of Defense
Counsel.
	Helen T. Dziuba, Portland, filed a brief on behalf of amicus
curiae Oregon Trial Lawyers Association.
	Before Carson, Chief Justice, and Gillette, Durham, Leeson,
Riggs, and De Muniz, Justices.**
	DURHAM, J.
	The decision of the Court of Appeals and the judgment of the
circuit court are affirmed.
	*Appeal from Multnomah County Circuit Court, Henry Kantor, Judge. 165 Or App 543, 997 P2d 265 (2000).
	**Balmer, J., did not participate in the consideration or
decision of this case.
	DURHAM, J.
	This is an action to recover damages for injuries that
plaintiff received during a surgical operation.  The issue is
whether plaintiff commenced the action after expiration of the
two-year period of limitations set out in ORS 12.110(4), quoted
below.  The trial court concluded that plaintiff's action was
time-barred and granted summary judgment, ORCP 47, in favor of
defendant Nesler. (1)  The Court of Appeals affirmed.  Greene v.
Legacy Emanuel Hospital, 165 Or App 543, 997 P2d 265 (2000).  For
the following reasons, we also affirm.
	We review the record on summary judgment in the light
most favorable to the non moving party below -- here, plaintiff 
-- and draw all reasonable inferences from the facts in her
favor.  Jones v. General Motors Corp., 325 Or 404, 420, 939 P2d
608 (1997).
	On July 26, 1995, plaintiff entered Legacy Emanuel
Hospital so that her physician, Nesler, could perform outpatient
surgery to abort a fetus with severe abnormalities.  During the
procedure, Nesler perforated plaintiff's uterine wall and colon
with forceps.  Nesler completed the abortion and other doctors
repaired the perforations.  The surgery lasted six hours and led
to an 11-day recuperation in the hospital.  Plaintiff has
suffered permanent injuries from the surgical complication.
	Plaintiff retained a lawyer, Zeitz, to represent her in
connection with the surgery.  On August 22, 1995, Zeitz sent the
hospital a request for a copy of plaintiff's medical records.  On
November 10, 1995, the hospital provided the pertinent records to
Zeitz.  On May 14, 1996, Zeitz sent a letter to the hospital and
Nesler offering to settle plaintiff's claims.  The letter
described in detail the injuries that plaintiff suffered during
the surgery. (2)  
	In March 1997, plaintiff retained another lawyer,
Miller, to represent her.  Miller obtained plaintiff's medical
records from Zeitz and sought an evaluation of plaintiff's case
from other physicians.  In June 1997, one of the physicians that
Miller had contacted opined that Nesler's surgical treatment of
plaintiff was negligent.  
	In an affidavit, plaintiff said the following regarding
her awareness of the pertinent facts:
		"* * * I did not discover that treatment I
received from Dr. Nesler, on or about July 26, 1995,
was somehow negligent until several months after the
initial procedure.  I was aware that a complication had
occurred which required me to remain in the hospital
for eleven (11) days after the initial procedure. 
Thus, I was aware of an injury and that the injury was
the result of Dr. Nesler's conduct.  But, I was not
made aware that Dr. Nesler was somehow negligent until
my attorney Sanford W. Zeitz had an opportunity to
review all requested medical information.
		"Attorney Zeitz requested all medical information
* * * on August 22nd, 1995.  The requested medical
information was not provided until on or about November
10th, 1995.  Thus, my attorney at that time had an
opportunity to have this medical information evaluated
by a medical doctor.
		"In March 1997, I retained Robert J. Miller, Sr.
to take over representation of my case.  Mr. Miller
obtained all medical information from attorney Zeitz
and had it evaluated by two medical doctors.  One of
the physicians agreed and informed me that Dr. Nesler's
conduct was outside the standards of care for this
community.  This was the first time that I had actual
confirmation of negligent conduct by Dr. Nesler.  It
was approximately during the month of June 1997 when I
received confirmation of the negligent treatment.
		"Thus, my first opportunity for discovering the
negligent conduct of Dr. Nesler was on or about
November 10th, 1995 when medical information was
provided to attorney Zeitz.  But still, it wasn't until
approximately June of 1997 that I had actual
confirmation of the negligent treatment."
	Plaintiff filed a complaint against defendants on July
24, 1997, and served Nesler with the complaint on November 14,
1997.  Because plaintiff served Nesler more than 60 days after
she filed the complaint, ORS 12.020(1) requires that we deem the
action commenced on the date on which she served the complaint: 
November 14, 1997. (3)
	ORS 12.110(4) sets out the period of limitations that
governs plaintiff's action:
		"An action to recover damages for injuries to the
person arising from any medical, surgical or dental
treatment, omission or operation shall be commenced
within two years from the date when the injury is first
discovered or in the exercise of reasonable care should
have been discovered. * * *"
We must determine whether the record demonstrates that a factual
dispute exists about whether plaintiff "discovered or in the
exercise of reasonable care should have * * * discovered" her
injury more than two years before the date on which she commenced
her action, November 14, 1997.
	The two-year period of limitations in ORS 12.110(4)
begins on the date when a plaintiff discovers or, in the exercise
of reasonable care, should have discovered his or her "injury." 
In Gaston v. Parsons, 318 Or 247, 864 P2d 1319 (1994), this court
determined that the term "injury" has a well-accepted legal
meaning, that is, a "legally cognizable harm."  Id. at 253. 
Gaston also held that the term "injury" embraces three elements: 
(1) harm; (2) causation; and (3) tortious conduct.  Id. at 255.
	Plaintiff's affidavit, quoted above, makes clear that
she was aware, immediately after the surgical procedure, that she
had suffered an injury during the surgery and that Nesler's
conduct had caused the injury.  Nevertheless, she denies that she
learned that Nesler's conduct "was somehow negligent until my
attorney Sanford W. Zeitz had an opportunity to review all
requested medical information."  She also argues, however, that
she did not discover the "tortious conduct" element of her
"injury" until a doctor confirmed, many months after plaintiff
left the hospital, that Nesler's conduct constituted professional
negligence.  
	Plaintiff contends, in particular, that the Court of
Appeals misapplied the concept of "inquiry notice" that this
court discussed in Doe v. American Red Cross, 322 Or 502, 513-14,
910 P2d 364 (1996), by holding that the period of limitations
commences when the plaintiff begins to inquire about whether the
defendant's harmful conduct was tortious. (4)  According to
plaintiff, the statutory period commences when the plaintiff
discovers, as a result of any inquiry, that the defendant's
conduct was tortious.  In this instance, plaintiff asserts, she
discovered that information less than two years before she
commenced her action against Nesler.
	The conflicting arguments of the parties and amici
curiae demonstrate that legal shorthand is a poor substitute for
careful construction of statutory text.  We note, for example,
that the parties' use of an inartful catchphrase, "inquiry
notice," about the proper application of ORS 12.110(4), as
discussed below, has expanded rather than narrowed their
disagreement.  Particularly because this court's discussions in
case law may have contributed to the resulting confusion, we take
this opportunity to bring some clarity to our analysis of ORS
12.110(4).
	In Doe, this court borrowed the phrase "inquiry notice"
from one of the parties and used it to explain the application of
the period of limitations in ORS 12.110(4) to the particular
facts of that case.  This court stated:
	"[W]e conclude that plaintiff's knowledge in October
1987 of the harm caused to John Doe by HIV contaminated
blood supplied by the Red Cross would have put
plaintiff on inquiry notice of the existence of
tortious conduct by defendants, as a matter of law."
Doe, 322 Or at 515 (emphasis added).
		The phrase "inquiry notice" does not appear in ORS
12.110(4).  Before Doe, this court had used that phrase to
determine whether a person with some awareness of an unrecorded
interest in real property could claim the status of a bona fide
purchaser.  See High v. Davis, 283 Or 315, 333, 584 P2d 725
(1978) (describing "inquiry notice" as specie of constructive
notice regarding outstanding interests in land).  High cited Belt
et ux. v. Matson et al., 120 Or 313, 252 P 80 (1927), which did
not use the phrase "inquiry notice" but illustrated the pertinent
legal concept as follows:
	"The law has been well settled from early times in this
state that a subsequent purchaser with notice of an
outstanding unrecorded title, encumbrance or interest
in real property takes title subject to the outstanding
unrecorded title.  If the subsequent purchaser has
information sufficient to put him upon inquiry as to
such outstanding unrecorded title and reasonable
inquiry would lead to full information regarding such
unrecorded interest and he neglects to make such
inquiry, he takes title to the land charged with such
outstanding title or interest.
		"* * * * *
		"Carter v. Portland, 4 Or. 339, 350 [(1873)]:
		"'The general doctrine is, that whatever is
sufficient to direct the attention of a purchaser to
the prior rights and equities of third persons, and to
enable him to ascertain their nature by inquiry, will
operate as notice.'  Musgrove v. Bonser, 5 Or. 313, 317
[(1874)] (20 Am. Rep. 737)."
Belt, 120 Or at 320-21.
	Those passages demonstrate that the constructive notice
rule in the law of real property functions to determine whether a
purchaser of real property had imputed notice of unrecorded
interests in the property at the time of purchase.  By contrast,
the imputed discovery standard in ORS 12.110(4) functions to
determine when a reasonably careful plaintiff should have
discovered an injury, including the element of tortious conduct.  
	In view of that important distinction, we perceive a
risk of analytical error in the use of the phrase "inquiry
notice" in connection with ORS 12.110(4).  The period of
limitations in that statute commences from the earlier of two
possible events: (1) the date of the plaintiff's actual discovery
of injury; or (2) the date when a person exercising reasonable
care should have discovered the injury, including learning facts
that an inquiry would have disclosed.  In neither of those
circumstances does the period of limitations begin to run from
the plaintiff's discovery of facts that serve only to trigger a
duty to inquire about whether an injury has occurred.  Even if a
plaintiff acquires information about a surgical complication that
only would cause a reasonable person to inquire whether legally
cognizable harm has occurred, the period of limitations would
commence at some later point when, after inquiry, the facts
reasonably should disclose the existence of an actionable injury. 
To avoid that risk of confusion, we discourage the use of the
phrase "inquiry notice" in connection with the application of ORS
12.110(4).
	Gaston held that, under ORS 12.110(4), the commencement
of the period of limitations is not postponed until the plaintiff
acquires "[a]ctual knowledge that each element [of an injury] is
present."  318 Or at 256.  Indeed, as the discussion above
confirms, if the facts satisfy the "should have been discovered"
standard under that statute, then the period of limitations
commences notwithstanding the plaintiff's complete failure to
acquire actual knowledge of the injury.
	Gaston also discussed the proof necessary to establish
the element of "tortious conduct" for purposes of ORS 12.110(4):
		"Although 'tortious conduct' is an element of
injury under the discovery rule, a plaintiff does not
need to identify a particular theory of recovery before
the statute of limitations begins to run.  All that is
required is that the plaintiff discover that some
invasion of the legally protected interest at stake has
occurred.  For example, when a plaintiff discovers that
he or she has wrongfully been harmed by the conduct of
another, he or she need not further discover whether
the defendant's act was intentional or negligent for
the statute of limitations to begin to run.  Discovery
that the plaintiff's legally protected interest to be
free from physical harm at the hands of another had
been infringed is sufficient to satisfy the tortious
conduct element of the discovery rule."
Id. at 255 n 8.  Gaston cautions that the plaintiff's "mere
suspicion" about the occurrence of tortious conduct is
insufficient to commence the period of limitations.  Id. at 256. 
However, Gaston confirms that the "tortious conduct" element of
the requirement of "injury" under ORS 12.110(4) is satisfied, and
the period of limitations commences, if the record on summary
judgment demonstrates that the plaintiff either actually
discovered or, in the exercise of reasonable care, should have
discovered that the defendant violated the plaintiff's legally
protected interest to be free from physical harm at the hands of
another.   
	According to Gaston, the statutory requirement of
discovery, either actual or imputed, of tortious conduct is a
factual question that depends on the nature of the harm suffered,
the nature of the medical procedure, and all other relevant
circumstances.  Id. at 256.  Examining the significance of the
nature of the harm suffered, Gaston stated:
	"Although, in many instances, suffering an untoward
result after surgery may put a reasonable person on
notice of tortious conduct, certain untoward effects
can 'mask' tortious conduct.  A reasonable person that
experiences symptoms that are incidental to a
particular medical procedure may not be aware that he
or she has been a victim of tortious conduct:
			"'Normally, knowledge of injury as a result
of defendants' actions would put the injured party
on sufficient notice of defendants' tortious
conduct to commence the running of the statute. 
However, immediate, adverse side effects commonly
result from medical treatment given to gain long-range and more important benefits.  Knowledge of
momentary, adverse effects which are immediately
controlled would not put plaintiff on notice as a
matter of law of tortious conduct by defendants.' 
Frohs v. Greene, [253 Or 1, 7, 452 P2d 564
(1969)]."
Id. at 256-57.
	Gaston illustrates how the factors mentioned in that
passage might lead to the conclusion that a plaintiff's knowledge
of undesired effects from surgery does not necessarily establish
discovery, actual or imputed, of an injury for purposes of ORS
12.110(4).  In Gaston, the plaintiff was a partial quadriplegic
whose only functioning limb was his left arm.  To treat muscle
spasms in the plaintiff's lower body, the defendant physician,
Parsons, suggested a spinal injection of chemicals.  The
physician did not warn the plaintiff of a risk of loss of
function in his arm.  After the injection, the plaintiff's arm
was numb and did not function.  The physician assured the
plaintiff that the loss of function was temporary, but the
plaintiff never regained the use of his arm.  The plaintiff filed
an action against the physician more than two years after he lost
the use of his arm.  Id. at 251.
	Addressing the physician's statute of limitations
defense, the court held that
	"Plaintiff's symptoms were not so clearly unrelated to
the procedure performed that as a matter of law a
reasonable person would believe that the cause was
tortious conduct.  In addition, Parsons assured
plaintiff that the numbness and loss of use that
plaintiff experienced in his left arm was temporary. 
The assurance raises a genuine issue of fact as to its
effect upon a reasonable person."
Id. at 258.
	The Gaston court cited the following passage from Berry
v. Branner, 245 Or 307, 312-13, 421 P2d 996 (1966), in support of
its analysis of ORS 12.110(4):
		"The objective of a statutory limitation on the
time within which an action may be brought is, in
malpractice cases, the protection of medical
practitioners from the assertion of stale claims.  We
do not believe the legislature intended to limit
patients asserting malpractice claims, who by the very
nature of the treatment had no way of immediately
ascertaining their injury, to the same overall period
of time that is allowed for bringing other tort actions
that are normally immediately ascertainable upon
commission of the wrong.  The protection of the medical
profession from stale claims does not require such a
harsh rule.  The mischief the statute was intended to
remedy was delay in the assertion of a legal right by
one who had slumbered for the statutory period during
which process was within his reach."
In Berry, a surgeon had left a needle in a patient's body during
surgery.  This court held that the period of limitations on the
patient's claim commenced when the patient discovered that the
cause of her post-surgical pain was the surgeon's error in
leaving a needle in her body, stating:
	"To say that a cause of action accrues to a person when
she may maintain an action thereon and, at the same
time, that it accrues before she has or can reasonably
be expected to have knowledge of any wrong inflicted
upon her is patently inconsistent and unrealistic.  She
cannot maintain an action before she knows she has
one."
Id. at 312.
	Also pertinent to this discussion is Doe v. American
Red Cross.  In Doe, a doctor transfused the plaintiff's decedent
during surgery in 1985 with blood supplied by the American Red
Cross.  Over two years later, the doctor informed the decedent
that the blood might have been contaminated with Human
Immunodeficiency Virus (HIV).  The decedent knew that that virus
could cause Acquired Immunodeficiency Syndrome (AIDS) and was
potentially life-threatening.  In 1990, the decedent sued.  In
1991, the decedent died from the effects of the contaminated
blood and AIDS.  Discussing the requirement in ORS 12.110(4) of
discovery, actual or imputed, of injury, including "tortious
conduct," this court stated:
	"In the ordinary case, that last element [i.e.,
tortious conduct] will appear as a matter of course. 
This, however, is not an ordinary case, because of the
nascent state of the law and science with respect to
HIV and AIDS at the pertinent time.
		"* * * [Although plaintiff had a duty to inquire
regarding the existence of tortious conduct by the
defendants,] the existence of a duty to inquire does
not foreclose the possibility of a factual dispute
concerning the question of what the Does would have
learned.  Application of the discovery rule's 'knew or
should have known' standard makes the issue of what the
Does 'should have known' about the possibility of
defendants' 'tortious conduct' an issue of material
fact."
322 Or at 515.  Doe thus recognizes that the circumstances
surrounding an adverse medical outcome might permit a reasonably
careful person to discover only the possibility of the
defendant's tortious conduct, rather than its existence, and give
rise to a duty to inquire.  In that circumstance, according to
Doe, factual questions about what the plaintiff should have
discovered likely will persist until the facts learned as the
result of an inquiry would cause a reasonable person to discover
that tortious conduct occurred.  
	We turn next to the application of the law discussed
above to the facts of this case.  Frohs, Gaston, and Doe confirm
that, in the ordinary medical malpractice case, a plaintiff's
awareness that a medical procedure has resulted in a distinct
injury, and that the defendant doctor's actions caused that
injury, will establish the plaintiff's discovery, either actual
or imputed, of the defendant's tortious conduct for purposes of
ORS 12.110(4).  As the discussion below demonstrates, this case
appears to be such an ordinary case.  When plaintiff left the
hospital in August 1995, and clearly from the time that
plaintiff's lawyer received a copy of her medical records on
November 10, 1995, plaintiff had discovered or reasonably should
have discovered that, during the abortion procedure on July 26,
1995, Nesler had perforated her uterine wall and colon with
forceps. 
	The cases also indicate that certain special
circumstances surrounding a medical procedure can create a
factual question about whether the plaintiff discovered or should
have discovered the presence of tortious conduct from the fact of
injury at a physician's hands.  However, the record in this case
fails to establish the presence of any of those special
circumstances.  The perforations to plaintiff's uterine wall and
colon were not momentary adverse side effects that commonly
result from the abortion procedure to which plaintiff had
consented.  The perforations were a distinct injury.  Nothing
about the abortion procedure or its adverse effects masked the
injury that plaintiff suffered.  In contrast to Gaston, the
record does not suggest that Nesler downplayed either the fact or
likely consequences of the perforations or made any false or
misleading statement about the injury to plaintiff.  In contrast
to Doe, this case involves no novel principle or procedure of
medical science and no uncertainty regarding the state of the
law.  The record contains no other factual assertion that would
support a conclusion that a reasonably careful plaintiff might
not have discovered Nesler's tortious conduct from the injury
that occurred during surgery.  To paraphrase Berry, plaintiff is
not a patient who had no way of immediately ascertaining her
injury.
	Plaintiff emphasizes that, according to her affidavit,
she did not receive "actual confirmation of negligent conduct by
Dr. Nesler" until March 1997, when another doctor examined her
medical records.  We acknowledge, as this court stated in Gaston,
318 Or at 256, that the nature of the harm suffered, the nature
of the medical treatment received or other relevant circumstances
may delay or prevent the discovery of tortious conduct until a
separate medical evaluation or diagnosis occurs and, thus, create
a factual question about discovery that precludes summary
judgment.  But, on the present record, the medical opinion that
plaintiff received in March 1997 served only to confirm the
discovery of tortious conduct that plaintiff reasonably should
have made when she learned, soon after surgery, that the
perforations had occurred.  In other words, the facts that
plaintiff knew regarding her injury did not induce mere
suspicions that might have given rise to a duty to make an
inquiry to confirm whether tortious conduct had occurred.  The
facts that plaintiff knew regarding her injury satisfied the
standard in ORS 12.110(4) for discovery, actual or imputed, of
tortious conduct.  The following statement by this court in
Schiele v. Hobart Corporation, 284 Or 483, 490, 587 P2d 1010
(1978), is pertinent here:
	"[W]e reject plaintiff's contention that nothing short
of a positive diagnosis by a physician will [commence
the period of limitations].  A plaintiff whose
condition has not yet been diagnosed by a physician can
have or, in the exercise of reasonable care, could have
access to information which requires or would require a
reasonable person to conclude she is being seriously or
permanently injured."
	From the foregoing, we conclude that, on the present
record, plaintiff discovered or reasonably should have discovered
that she had suffered an "injury," that is, legally cognizable
harm resulting from Nesler's actions, when she learned of the
injury in the hospital and certainly no later than her lawyer's
receipt of her medical records on November 10, 1995.  Plaintiff
did not file her action until more than two years had elapsed
from that date.  Because no genuine issue of material fact exists
regarding those events, the trial court did not err in granting
summary judgment for Nesler.
	The decision of the Court of Appeals and the judgment
of the circuit court are affirmed.


1. 	The record on review presents no issue regarding the
liability of the other defendant, Legacy Emanuel Hospital and
Health Care Center.

2. 	In that letter, the lawyer stated:
		 "Due to the negligence of Dr. Nesler and Emanuel
Hospital, Ms. Greene's posterial [sic] uterine wall was
torn open.  The tear was deep enough and severe enough
to also tear into my client's bowels."
The letter also described the pain and permanent consequences
that plaintiff suffered from the alleged negligent surgery.  The
record contains no evidence that the lawyer relied on an expert
witness's evaluation of plaintiff's medical records in stating
that description of plaintiff's injuries.  From all that appears
in the record, plaintiff's description of her injuries to the
lawyer and plaintiff's medical records, which the lawyer received
on November 10, 1995, enabled the lawyer to describe plaintiff's
injuries in detail in the May 14, 1996, letter.

3. 	ORS 12.020 provides:
		"(1)  Except as provided in subsection (2) of this
section, for the purpose of determining whether an
action has been commenced within the time limited, an
action shall be deemed commenced as to each defendant,
when the complaint is filed, and the summons served on
the defendant, or on a codefendant who is a joint
contractor, or otherwise united in interest with the
defendant.
		"(2)  If the first publication of summons or other
service of summons in an action occurs before the
expiration of 60 days after the date on which the
complaint in the action was filed, the action against
each person of whom the court by such service has
acquired jurisdiction shall be deemed to have been
commenced upon the date on which the complaint in the
action was filed."
The facts of this case render the 60-day provision described in
ORS 12.020(2) inapplicable. 

4. 	Plaintiff relies for her argument on the following
passage from the opinion of the Court of Appeals:
	"Here, plaintiff was aware that her colon had been
perforated during an outpatient procedure that resulted
in an 11-day stay in the hospital.  Although not all
surgical complications in every circumstance will put a
patient on inquiry notice as to medical malpractice,
our review of the summary judgment record in this case
persuades us that a reasonable person in plaintiff's
position would have known of a substantial possibility
of malpractice when informed of the nature of the
complication.  The trial court did not err in ruling
that the two-year statute of limitations ran before
plaintiff commenced her action."
Greene, 165 Or App at 549-50.