Case Title: GI Associates of Delaware v. Anderson

Citation: 

Docket Number: 182, 2020

State: delaware

Court: Delaware Supreme Court

Date: 2021-02-15T00:00:00Z

Document:
IN THE SUPREME COURT OF THE STATE OF DELAWARE 
 
GI ASSOCIATES OF DELAWARE, 
P.A., ADVANCE ENDOSCOPY 
CENTER, LLC, and NATWARLAL 
RAMANI, M.D., 
 
Defendants Below,  
Appellants, 
 
v. 
 
MONICA KING ANDERSON, 
Individually and as Personal 
Representative of the ESTATE OF 
WILLIAM KING, STEPHANIE 
KING, HEATHER GUERKE, and 
AMBER WITHROW, 
 
Plaintiffs Below,  
Appellees. 
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No.  182, 2020 
 
Court Below:  Superior Court 
of the State of Delaware 
 
C.A. No. N18C-04-158 
 
 
Submitted:  December 9, 2020 
Decided:  February 15, 2021 
 
 
Before SEITZ, Chief Justice; VALIHURA, VAUGHN and TRAYNOR, Justices; 
and HARTNETT, Judge,* constituting the Court en Banc. 
 
 
Upon appeal from the Superior Court.  REVERSED and REMANDED. 
 
 
Bradley J. Goewert, Esquire, and Lorenza A. Wolhar, Esquire (Argued), Marshall 
Dennehey Warner Coleman & Goggin, Wilmington, Delaware, for Appellants, GI 
Associates of Delaware, P.A., Advance Endoscopy Center, LLC, and Natwarlal 
Ramani, M.D. 
 
 
* Sitting by designation under Del. Const. Art. IV, § 12. 
 
 
Timothy E. Lengkeek, Esquire (Argued), and Natalie Wolf, Esquire, Young 
Conaway Stargatt & Taylor, LLP, Wilmington, Delaware, for Appellees, Monica 
King Anderson, Individually and as Personal Representative of the Estate of William 
King, Stephanie King, Heather Guerke, and Amber Withrow. 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
VAUGHN, Justice:
 
 
1 
I. 
INTRODUCTION 
This is an interlocutory appeal in a medical negligence case.  The 
Defendants-Appellants are GI Associates of Delaware, P.A., Advance Endoscopy 
Center, LLC, and Natwarlal Ramani, M.D. (“Dr. Ramani”) (collectively, the 
“Defendants”).  The Plaintiffs-Appellees are Monica King Anderson, the Estate of 
William King, Stephanie King, Heather Guerke, and Amber Withrow (collectively, 
the “Plaintiffs”). 
On April 4, 2011, Dr. Ramani performed a colonoscopy on William King.    
At a follow up visit on April 26, 2011, Dr. Ramani recommended that Mr. King 
return for his next colonoscopy in three to five years.   Mr. King followed that 
advice and returned to Dr. Ramani for another colonoscopy five years later, on 
March 26, 2016.  The March 2016 colonoscopy could not be completed because a 
cancerous growth had formed in Mr. King’s colon.  He died a few months later.  
On April 16, 2018, the Plaintiffs filed this wrongful death action, claiming that Dr. 
Ramani was negligent in advising Mr. King that he did not need a follow-up 
colonoscopy until as long as five years after the one done in April 2011.  Given Mr. 
King’s medical history, they allege, the standard of care required Dr. Ramani to 
advise Mr. King to return for his next colonoscopy in three years.  The negligent 
advice, they further allege, resulted in a delay in the diagnosis and treatment of colon 
cancer which ultimately led to Mr. King’s death.   
 
 
2 
The Defendants filed a motion for summary judgment in which they argued 
that the Plaintiffs’ action was barred by the statute of limitations.  18 Del. C. § 6856 
requires that a medical negligence action be brought within two years of the “date 
upon which such injury, [i.e., personal injury] occurred,” or, if the injury is unknown 
to the injured person and cannot be discovered through the exercise of reasonable 
diligence within two years of the date of injury, within three years of the date of 
injury.  They argued that under this Court’s precedents, “the date upon which the 
injury occurred, for purposes of the [medical negligence statute of limitations, is] the 
date of the alleged wrongful act or omission,” i.e. April 26, 2011.2  The Plaintiffs 
made a number of arguments in opposition to the motion, including the argument 
that the Superior Court should apply the continuous negligent medical treatment 
doctrine and find that the statute did not begin to run until Dr. Ramani attempted to 
perform the colonoscopy on March 26, 2016.   
The Superior Court found that the continuous negligent medical treatment 
doctrine applies to the facts of this case and held that under that doctrine the statute 
did not begin to run until March 26, 2016.3  Before filing suit, the Plaintiffs sent a 
Notice of Intent to investigate medical negligence to the Defendants pursuant to 18 
Del. C. § 6856(4), which had the effect of tolling the statute for 90 days, which meant 
 
2 App. to Appellants’ Opening Br. at 74 [hereinafter A__] (quoting Dunn v. St. Francis Hospital, 
Inc., 401 A.2d 77, 80 (Del. 1979)). 
3 See Anderson v. GI Assoc. of Del., P.A., 2020 WL 2070342, at *6 (Del. Super. Apr. 28, 2020). 
 
 
3 
that if the statute ran from March 26, 2016, the Plaintiffs’ complaint was timely filed.     
We accepted this appeal to review the Superior Court’s ruling that the 
continuous negligent medical treatment doctrine applies to the facts of this case.  
For the reasons discussed below, we find that the continuous negligent medical 
treatment doctrine does not apply.  We also address the Defendants’ contention that 
the injury occurred on the date of Dr. Ramani’s alleged negligence on April 26, 2011. 
II. 
FACTS AND PROCEDURAL HISTORY 
Dr. Ramani, a gastroenterologist, performed a number of colonoscopies on 
Mr. King, who was at high risk of developing colon cancer.  A colonoscopy was 
performed on April 4, 2011, which showed benign tumors in Mr. King’s colon.  At 
a follow-up visit on April 26, 2011, Dr. Ramani recommended that Mr. King should 
return for another colonoscopy in three to five years. 
Steven F. Moss, M.D. is the Plaintiffs’ expert witness.  Dr. Moss opined that, 
after the 2011 colonoscopy, the standard of care required a repeat colonoscopy 
within three years.4  Further, Dr. Moss opined that had Mr. King’s cancer been 
diagnosed in 2014, it would have been treatable, and Mr. King would have had a 
much better prognosis.5  Dr. Moss also opined that apart from the alleged negligent 
recommendation that Mr. King return for another colonoscopy in three to five years 
 
4 A163 (Dr. Moss Dep. Tr. at 71:3-8). 
5 A159-60, 163-64 (Dr. Moss Dep. Tr. at 67:15-68:5, 71:22-72:13). 
 
 
4 
instead of three years, Dr. Ramani did not otherwise breach the standard of care.6 
In their motion for summary judgment, the Defendants argued that under 18 
Del. C. § 6856, the statute of limitations expired at the latest on April 26, 2014 
because, they argued, under this Court’s precedents, the date of injury is the same as 
the date of the negligent act.  In addition, they argued that this was a single act of 
negligence and that the continuous negligent medical treatment doctrine does not 
apply. 
In their opposition to the motion, the Plaintiffs made several arguments in the 
alternative.  They argued that the Superior Court should “[a]dopt a limited 
discovery rule where there is no injury in the two (or three years) following the 
alleged negligence;”7 that the Court should extend the continuous negligent medical 
treatment doctrine to the last act related to the original negligence, whether or not 
such act was negligent; that the Plaintiffs’ claims are not barred by the two year 
limitations period contained in § 6856 because such an application violates the 
Delaware Constitution; that the Plaintiffs’ claims are not barred because such an 
application of § 6856 unconstitutionally treats similarly situated claimants 
differently; and that the Plaintiffs’ claims are not barred because the two year period 
of limitations in § 6856 violates due process.    
 
6 A117 (Dr. Moss Dep. Tr. at 25:17-20). 
7 A318. 
 
 
5 
In its opinion denying the Defendants’ motion, the Superior Court reasoned 
that “[f]or purposes of Section 6856, the date upon which the ‘injury’ occurred 
depends on whether the case involves a single act of negligence or a continuous 
course of negligent medical treatment.”8  In discussing the statute of limitations and 
single acts of negligence, the court made the following observation: 
With respect to single acts of negligence, the decisional 
law is well-settled.  The Delaware Supreme Court has 
consistently held that where there is a single act of medical 
negligence, typically a misdiagnosis or a failure to 
diagnose, the statute of limitations for medical negligence 
begins to run on the date that the single act of negligence 
occurred.9 
The court drew this conclusion from our decisions in Dunn v. St. Francis 
Hospital, Inc.,10 Meekins v. Barnes,11 and Dambro v. Meyer.12 
The court found that the cases involving a single act of negligence were not 
applicable to the facts of this case: 
Defendants’ reliance on the decisional law involving 
single acts of negligence is misplaced for several reasons.  
First, the case before the Court does not involve a single 
act of negligence but instead involves a continuous course 
of negligent medical treatment, which is a separate and 
distinct cause of action subject to a different section 6856 
analysis.  Second the decisional law involving single acts 
 
8 Anderson, 2020 WL 2070342, at *2. 
9 Id. 
10 401 A.2d 77 (Del. 1979). 
11 745 A.2d 893 (Del. 2000) (en banc). 
12 974 A.2d 121 (Del. 2009). 
 
 
6 
of negligence is not applicable where, as here, the injury 
and the negligence did not take place on the same date.13 
The court elaborated on its finding that the alleged negligence and the injury 
did not occur on the same date: 
Unlike the injuries in the cases involving single acts of 
negligence, Mr. King’s injury did not arise at the time of 
the alleged breach of the standard of care.  There is no 
record evidence that Mr. King had cancer which was 
missed or misdiagnosed by Dr. Ramani during the April 4, 
2011 colonoscopy. 
. . . . 
. . . Here, the date of negligence and the date of injury are 
two separate dates.  Accordingly, the decisional law 
involving single acts of negligence does not apply to 
Plaintiffs’ claims.  Instead, application of Section 6856 
to Plaintiffs’ claims is governed by the continuous 
negligent medical treatment doctrine.14 
The court then proceeded to analyze the continuous negligent medical 
treatment doctrine, found that it applied to the facts of this case, and concluded that 
the statute of limitations began to run on the date of Dr. Ramani’s last treatment of 
Mr. King, when his cancer was discovered on March 26, 2016.   
On appeal, the Defendants make two claims.  First, they claim that the 
continuous negligent medical treatment doctrine does not apply to the facts of this 
case.  Second, they claim that “the term ‘injury’ as it appears in 18 Del. C. § 6856 
 
13 Anderson, 2020 WL 2070342, at *3 (internal citation omitted). 
14 Id. at *3, 4. 
 
 
7 
is defined as when the alleged act of negligence took place, not some other vague 
and undefined date of injury.”15  
The Plaintiffs assert five claims.  First, Plaintiffs claim that the Superior 
Court’s ruling that the continuous negligent medical treatment doctrine applies and 
that the statute runs from March 26, 2016 is correct and should be affirmed.  
Second, they claim that “‘injury’ under 18 Del. C. § 6856, however defined, is 
irrelevant to the central issue of whether the Superior Court correctly applied the 
continuous negligent medical treatment doctrine.”16  Next, they claim that if this 
Court does not affirm on the basis of the Superior Court’s ruling, it should extend 
the continuous negligent medical treatment doctrine to encompass the facts 
presented here.  Next, they claim this Court should “adopt a limited discovery rule 
in cancer cases” and overrule our precedents inconsistent with such a rule. 17  
Finally, they repeat the constitutional arguments they made in the Superior Court. 
III. 
STANDARD OF REVIEW 
This Court reviews a denial of summary judgment de novo “to determine 
whether, viewing the facts in the light most favorable to the nonmoving party, the 
moving party has demonstrated that there are no material issues of fact in dispute 
 
15 Appellants’ Opening Br. at 19. 
16 Appellees’ Answering Br. at 13. 
17 Id. at 20. 
 
 
8 
and that the moving party is entitled to judgment as a matter of law.”18 
“Questions of law, including the interpretation of statutes, are also reviewed 
de novo.”19 
IV. 
DISCUSSION 
Under 18 Del. C. § 6856, “No action for the recovery of damages upon a claim 
against a health care provider for personal injury, including personal injury which 
results in death, arising out of medical negligence shall be brought after the 
expiration of 2 years from the date upon which such injury occurred.”  However, if 
the personal injury “was unknown to and could not in the exercise of reasonable 
diligence have been discovered by the injured person” during the two year period, 
“such action may be brought prior to the expiration of 3 years from the date upon 
which such injury occurred.”20 
A. 
 
This Court first recognized the continuous negligent medical treatment 
doctrine in Ewing v. Beck.21  The Court explained that: 
When there is a continuum of negligent medical care 
related to a single condition occasioned by negligence, the 
plaintiff has but one cause of action—for continuing 
negligent medical treatment.  If any act of medical 
negligence within that continuum falls within the period 
 
18 Homeland Ins. Co. of N.Y. v. CorVel Corp., 197 A.3d 1042, 1046 (Del. 2018) (en banc). 
19 City of Wilm. v. Nationwide Ins. Co., 154 A.3d 1124, 1127 (Del. 2017). 
20 18 Del. C. § 6856(1). 
21 520 A.2d 653 (Del. 1987). 
 
 
9 
during which suit may be brought, the plaintiff is not 
obliged to split the cause of action but may bring suit for 
the consequences of the entire course of conduct.22 
 
In determining whether there is a continuum of negligent medical care related 
to a single condition occasioned by negligence, the facts alleged by the plaintiff  
“must be examined to see if the negligent treatment, as alleged, can be segmented or 
is, in fact, so inexorably intertwined that there is but one continuing wrong.”23  If 
supported by the facts in the record, “the statute of limitations runs from the date of 
the last act in the negligent continuum.”24  The doctrine requires that there be a 
continuum of negligent medical care, that is, negligent care which is continuous and 
uninterrupted for some period of time.  Where that is the case, the plaintiff is not 
required to split his or her cause of action between the parts of the continuum, but 
may bring a single cause of action for the entire continuum of negligent medical care 
if any part of it occurs within the time required by the statute of limitations. 
 
The continuous negligent medical treatment doctrine can be contrasted with 
the continuing treatment doctrine, under which the statute of limitations begins “to 
run on the last day the plaintiff received treatment from the defendant health care 
provider for the same or a related condition which is the subject matter of the 
 
22 Id. at 662 (citing Tamminen v. Aetna Cas. & Sur. Co., 327 N.W.2d 55, 64 (Wis. 1982) (emphasis 
in original)). 
23 Id. (citing Streitz v. LeRoy, C.A. No. 84C-OC-127 (Del. Super. Ct. Apr. 28, 1986)). 
24 Id. (citing Oakes v. Gilday, 351 A.2d 85 (Del. Super. Ct. 1985)). 
 
 
10 
Complaint, whether or not negligence continued throughout the entire course of 
treatment.”25  Under the continuing treatment doctrine, the statute of limitations is 
measured from the time that treatment of a condition is completed, and an action 
filed within the time allowed from that date is considered timely even if no 
negligence occurred during the limitations period.  “The difference between the 
two doctrines, for statute of limitations purposes, is that under the doctrine of 
continuous negligent medical treatment, the focus is limited to the last act in the 
negligent continuum, not the last act in the treatment.”26  The continuing treatment 
doctrine has been recognized in many jurisdictions, but it has been rejected in this 
state as being inconsistent with § 6856.27 
 
If the continuing treatment doctrine were the law in this state, it could be 
argued that the colonoscopy that Dr. Ramani performed, or attempted to perform, on 
March 26, 2016 was the last act in a continuous course of treatment and the statute 
of limitations runs from that date.  The continuous negligent medical treatment 
doctrine which this state has adopted, however, requires more.  Under that doctrine, 
the statute runs from the last act in the continuum of negligent treatment.  Here, 
there is no allegation that any negligence was associated with the colonoscopy Dr. 
Ramani attempted to perform on March 26, 2016 or that he was negligent in any 
 
25 Id. at 659 (emphasis in original). 
26 Benge v. Davis, 553 A.2d 1180, 1183 (Del. 1989) (citing Ewing, 520 A.2d at 663, n.11). 
27 See Ewing, 520 A.2d at 659-61. 
 
 
11 
way on that occasion.  The March 26, 2016 procedure, therefore, is not an act in a 
continuum of negligent medical treatment.  Since the treatment on March 26, 2016 
does not fall within the alleged continuum of negligent medical treatment, the 
Plaintiffs’ claim collapses into a single act of alleged medical negligence occurring 
on April 26, 2011 and the continuous negligent medical treatment doctrine is of no 
avail to them.  The Superior Court erred by finding that the continuing negligent 
treatment doctrine applies to the facts of this case. 
B. 
We now turn to the Defendants’ argument that in a case involving a single act 
of negligence, the date of injury is defined as being the same as the date of 
negligence.  As discussed above, the Superior Court stated in its opinion that this 
Court’s decisional law is well settled that where there is a single act of alleged 
medical negligence, the statute of limitations runs from the date of the alleged 
negligence.  Appellants’ counsel has taken the same position in this Court, arguing 
that under this Court’s precedents, the statute of limitations runs from Dr. Ramani’s 
act of alleged negligence on April 26, 2011.  If that is so, the statute has clearly run 
because the action was filed more than three years after Dr. Ramani’s alleged 
negligence.  For the reasons that follow, however, we do not believe that our 
finding that the continuous negligent medical treatment doctrine does not apply 
resolves the statute of limitations issue.   
 
 
12 
The Superior Court’s decision to find that the continuous negligent medical 
treatment doctrine applies in this case was influenced, it appears to us, at least in part 
by that court’s finding that “[u]nlike the injuries in the cases involving single acts of 
negligence, Mr. King’s injury did not arise at the time of the alleged breach of the 
standard of care.”28  The Superior Court’s finding that Mr. King’s injury did not 
arise at the time of the alleged negligent advice appears to be supported by the 
record.  The April 2011 colonoscopy, it appears, revealed only benign tumors.   
We will discuss the cases which caused the Superior Court and Appellants’ 
counsel to believe that it is well-settled that where a single act of negligence is 
involved, the statute of limitations must run from the date of the alleged negligent 
act. 
  The first such case is Dunn v. St. Francis Hospital, Inc.29 In that case the 
doctor performed a back operation on the plaintiff, Fred Dunn, on July 13, 1970.  
Dunn’s symptoms necessitating the operation were on the left side of his back.  
However, the doctor entered Dunn’s back on the right side.  In April of 1975 Dunn 
started experiencing pain in his right leg.  Later, in January of 1977, Dunn learned 
that his leg pain may have been caused by negligence during the 1970 back 
operation.  On March 10, 1977, Dunn sued the doctor and the hospital where the 
 
28 Anderson, 2020 WL 2070342, at *3. 
29 401 A.2d 77 (Del. 1979). 
 
 
13 
operation took place.  The defendants raised the statute of limitations as a defense.  
The Court stated that the case presented “the question of whether the statute of 
limitations commenced to run when the negligent act or omission was committed or 
when the harm first manifested itself to the patient.”30  
Before considering the Court’s analysis in Dunn, it is helpful to consider the 
background of the law in this area at the time Dunn was decided.  For this, we must 
discuss the well-known case of Layton v. Allen, which established the time-of-
discovery rule in this jurisdiction.31  Layton was a medical negligence case.  In 
1958, Dr. Layton operated on Anna Pearl Allen’s abdomen to correct a hernia.  He 
left a medical instrument several inches long in Allen’s body when the operation 
was concluded.  It was not until seven years later, in 1965, that Allen began to 
experience pain in her abdomen.  When she consulted with a physician about her 
pain, x-rays revealed the instrument which had been left in her abdomen.  This led 
to an emergency operation for removal of the instrument.  Three additional 
surgeries were required to repair the damage caused by the instrument and the 
passage of time. 
At that time there was no specific statute of limitations for medical negligence 
actions.  They were governed by a forerunner version of the general, two year 
 
30 Id. at 78. 
31 246 A.2d 794 (Del. 1968). 
 
 
14 
statute of limitations for actions based on personal injuries now found at 10 Del. C. 
§ 8107.  The statute, then at 10 Del. C. § 8118, provided that “No action for the 
recovery of damages upon a claim for alleged personal injuries shall be brought after 
the expiration of 2 years from the date upon which it is claimed that such alleged 
injuries were sustained.”  The Court in Layton held that: 
[W]hen an inherently unknowable injury, such as is here 
involved, has been suffered by one blamelessly ignorant 
of the act or omission and injury complained of, and the 
harmful effect thereof develops gradually over a period of 
time, the injury is ‘sustained’ under § 8118 when the 
harmful effect first manifests itself and becomes 
physically ascertainable.32 
In other words, the Court determined in that case that the date of Allen’s injury 
was the date upon which the injury manifested itself in 1965, not the date of the 
operation.        
In Dunn, the plaintiffs made an argument which was consistent with Layton.  
They argued that “there was no damage until April 1975 when pain was experienced 
and until that date the ‘injury’ had not ‘occurred.’”33 
Dunn’s case was governed by 18 Del. C. § 6856, which became effective on 
April 26, 1976.  Applying that statute, the Court rejected Dunn’s argument, stating: 
This limited extension[, from two to three years,] of the 
[two-year] period, in our judgment, is intended to give 
consideration to the problem of an injury which is not 
 
32 Id. at 798. 
33 Dunn, 401 A.2d at 80. 
 
 
15 
physically ascertainable.  Such extension further appears 
directly intended to limit the open-ended aspect of the 
prior law which provided that in the case of an “inherently 
unknowable” injury that the applicable period began to run 
when the injured person became aware of his injury. . . It 
simply appears on the face of the statute that s 6856(1) is 
an attempt to codify the “inherently unknowable” injury 
rule of the Layton case and limit it to three years.34 
 
The Court then discussed the report to the Governor of the Delaware Medical 
Malpractice Commission.  The Court stated that the report of the Commission, 
which drafted § 6856, “clearly indicates that the phrase ‘injury occurred’ means the 
time at which the wrongful act or omission occurred.  The report, referring to § 
6856, reads in part: ‘[t]he overall effect will be to eliminate the uncertainty created 
by the present open-ended period of limitations.’”35  After discussing the report of 
the Commission, the Court concluded that “[t]hus, through examination of 
legislative history, there is no doubt that the phrase ‘injury occurred’ refers to the 
date when the wrongful act or omission occurred.”36  The Court thus rejected 
Dunn’s argument based on Layton and ruled that the statute of limitations ran “from 
the time when the wrongful act occurred and not from the time when that act was 
discovered.”37  In terms of the issue as framed, the Court found that the injury 
occurred at the time of the negligently performed operation, as opposed to the date 
 
34 Id. at 79 (citations omitted). 
35 Id. (quoting Report of the Delaware Medical Malpractice Commission, pp. 3-4, Feb. 26, 1976). 
36 Id. at 80. 
37 Id. at 81. 
 
 
16 
“when the harm first manifested itself to the patient.”38 
Meekins and Dambro were both cases involving a doctor’s failure to diagnose 
breast cancer after performing a mammogram.  In both cases, the Court followed 
Dunn and found that the injury occurred when the wrongful act or omission 
occurred.  In Meekins v. Barnes, the plaintiff-patient, Mary Meekins, had several 
mammograms performed at Women’s Imaging Center of Delaware (WIC) between 
1990 and December 1994.39  After each mammogram a radiologist, Dr. Susan 
Barnes, interpreted the films, discussed her interpretation of the films with Meekins, 
and advised Meekins to return for another mammogram in one year.  Dr. Barnes 
discussed the December 1994 mammogram with Meekins on December 21, 1994.  
In October of 1995, Meekins felt a lump in her breast.  She was examined by her 
family physician in late November, who then referred her to Dr. Abdel-Misish.  On 
December 1, 1995, Dr. Abdel-Misish confirmed the existence of two masses in 
Meekins’ left breast.  Dr. Abdel-Misish then performed a modified radical 
mastectomy on Meekins’ left breast on December 26, 1995.  On April 16, 1997, 
Meekins filed suit against Dr. Barnes, WIC, and Dr. Barnes’ employer.  She argued 
that “in December 1994, the radiologists were medically negligent by failing to 
diagnose [her] cancer.  [She] argue[d] that the statute of limitations did not begin 
 
38 Id. at 78. 
39 745 A.2d 893, 895 (Del. 2000) (en banc). 
 
 
17 
to run until she was damaged or ‘injured’ when the radiologists failed to call her 
back for another mammogram six months later in June of 1995.”40  June 1995 is 
when Meekins’ expert opined that Dr. Barnes should have recalled her for another 
mammography after the December 1994 mammogram.  The radiologists agreed 
that it could be assumed that negligence occurred in December 1994.  The Court 
rejected Ms. Meekins’ argument that the statute of limitations did not begin to run 
until six months after the December 1994 mammogram: 
An act of omission can be a valid basis for a plaintiff’s 
medical malpractice claim, if that act of omission occurs 
“within the context of an affirmative happening or event.”  
The only affirmative happening or event of the 
radiologists occurred at the time of the misdiagnosis in 
December 1994. 
It is artificial to predicate the commencement of the statute 
of limitations period, as Meekins’ argues, on the 
theoretical six-month period (i.e., June 1995) from the 
[sic] December 1994. . . . There was no cause of action 
that actually arose in June 1995 because no affirmative 
happening or event of medical negligence occurred at that 
time.41 
The Court, applying Dunn, ruled that the statute began running when Dr. 
Barnes negligently failed to diagnose Ms. Meekins’ cancer in December 1994.  The 
Court stated that “[i]n theory, Meekins could have brought an action at that time had 
Meekins known of the alleged negligent diagnosis, although her damages would be 
 
40 Id. at 897. 
41 Id. at 898 (internal citation omitted). 
 
 
18 
difficult to quantify.”42 
In Dambro v. Meyer, the plaintiff, Catherine C. Meyer, had seven 
mammograms performed by the defendants between 1997 and 2006.43  The first 
five exams were interpreted as normal and negative for cancer.  A March 8, 2005 
mammogram was interpreted the same.  A mammogram performed May 4, 2006 
was interpreted as highly suggestive of malignancy.  Meyer learned that she had a 
large lesion in her breast and, following a biopsy on May 18, 2006, learned that it 
was positive for cancer.  On October 24, 2007, Meyer filed suit.  She claimed 
“that the breast cancer was present and diagnosable during her March 8, 2005, 
mammogram and that defendants were negligent when they failed to diagnose the 
existence of cancer during that exam.”44  The Defendants argued that the statute of 
limitations began to run on the date of the negligent act, March 8, 2005, when the 
misdiagnosis occurred.  Meyer argued that the statute of limitations did not begin 
to run until her cancer metastasized on November 1, 2005.  Relying on Meekins, 
this Court held that Meyer’s argument failed because her injury occurred on the date 
of the allegedly negligent act, i.e., the defendants’ failure to diagnose the cancer on 
March 8, 2005.  This Court explained that under Dunn and Meekins, “the phrase 
‘injury occurred’ in section 6856 . . . ‘refers to the date when the wrongful act or 
 
42 Id. at 897. 
43 974 A.2d 121, 124 (Del. 2009). 
44 Id. at 125. 
 
 
19 
omission occurred.’”45  The injury, the Court further explained, “was the delay in 
treatment.  That injury occurred on the date that the cancer could have been 
diagnosed but was not.”46 
C. 
We can understand how one could interpret statements made by this Court in 
Dunn, Meekins, and Dambro as establishing an absolute rule that the date of the 
alleged negligent act or omission is the date of injury as a matter of law.  They 
contain statements which suggest that.  Those statements stem from the Court’s 
analysis of the legislative history of § 6856 in Dunn and the Court’s characterization 
of the report of the Delaware Medical Malpractice Commission as “clearly 
indicat[ing] that the phrase ‘injury occurred’ means the time at which the wrongful 
act or omission occurred.” 47  In Dunn, this Court was recognizing that newly 
enacted § 6856 and the Commission’s report in connection therewith were 
overruling Layton’s rule, as applied to medical negligence cases, that the date of the 
injury may be a date, perhaps years later, when the injury manifested itself, even 
though the injury was actually sustained on the date of the negligence. 
The rulings in Dunn, Meekins, and Dambro that the injury coincided with the 
negligence were all grounded in and supported by the evidence in those cases.  
 
45 Id. at 132 (quoting Meekins, 745 A.2d at 897). 
46 Id. 
47 Dunn, 401 A.2d at 79. 
 
 
20 
Under the unique facts of this case, however, the trial court has made a factual 
finding that “Mr. King’s injury did not arise at the time of the alleged breach of the 
standard of care.”48  That finding appears to be supported by the evidence.  The 
April 2011 colonoscopy revealed only benign tumors.  Under these facts, it appears 
that the injury occurred later, sometime after Dr. Ramani gave his allegedly 
negligent advice.  This is an unusual case, therefore, where the date of the negligent 
act and the occurrence of the injury do not coincide.     
V. 
CONCLUSION 
We reverse the Superior Court’s ruling that the statute of limitations began 
running on March 26, 2016 under the continuous negligent medical treatment 
doctrine.  We reject the Plaintiffs’ contention that the continuous negligent medical 
treatment doctrine should be extended to encompass the facts of this case.  We 
reject the Plaintiffs’ contention that we should adopt a limited time-of-discovery rule 
in cancer cases.  We do not address the Plaintiffs’ constitutional arguments.  They 
are not ripe unless and until it is determined that this action is, in fact, barred by the 
statute of limitations.  We reject the Defendants’ contention that the date of 
negligence and the date of injury are the same on the facts of this case.  The text of 
§ 6856 does not mandate that the date of negligence and the occurrence of injury 
 
48 Anderson, 2020 WL 2070342, at *3. 
 
 
21 
must be deemed to coincide, even where the facts of the case do not support such a 
finding.  
On remand, the Defendants are free to pursue their statute of limitations 
defense.  If they do, the Superior Court should make a factual determination as to 
when the date of injury occurred and apply § 6856 to that finding accordingly.  If 
the Superior Court determines that the action is barred by § 6856, the Plaintiffs may 
present their constitutional arguments there.   
The case is remanded to the Superior Court for further proceedings consistent 
with this opinion.  Jurisdiction is not retained.