Title: Ligons v. Crittenton Hospital

State: michigan

Issuer: Michigan Supreme Court

Document:

FILED JULY 29, 2011 
 
S T A T E  O F  M I C H I G A N 
 
SUPREME COURT 
 
 
DUJUAN LIGONS, Personal Representative 
of the Estate of EDRIS LIGONS, 
 
 
Plaintiff-Appellant, 
 
 
v 
No. 139978 
 
CRITTENTON HOSPITAL, a/k/a 
CRITTENTON HOSPITAL MEDICAL 
CENTER, DAVID BRUCE BAUER, M.D., 
and ROCHESTER EMERGENCY GROUP, 
P.C., 
 
 
 
Defendants-Appellees. 
 
 
 
BEFORE THE ENTIRE BENCH  
 
ZAHRA, J.  
 
We are called upon to answer the question whether a medical malpractice suit 
must be dismissed if a defective affidavit of merit (AOM) is filed after both the 
limitations period and the saving period have expired.  We hold that in such cases, 
dismissal with prejudice must follow because allowing amendment of the deficient AOM 
would directly conflict with the statutory scheme governing medical malpractice actions, 
 
Michigan Supreme Court
Lansing, Michigan
Opinion 
 
Chief Justice: 
Robert P. Young, Jr. 
 
 
Justices: 
Michael F. Cavanagh 
Marilyn Kelly 
Stephen J. Markman 
Diane M. Hathaway 
Mary Beth Kelly 
Brian K. Zahra 
 
 
 
 
 
2
the clear language of the court rules, and precedent of this Court.  Accordingly, we affirm 
the judgment of the Court of Appeals dismissing plaintiff’s case with prejudice. 
I.  FACTS AND PROCEDURAL HISTORY 
Edris Ligons underwent a colonoscopy on January 14, 2002, and four days later 
developed vomiting, diarrhea, chills, and fever.1  On January 22, 2002, still suffering 
from those symptoms, Ligons went to the emergency room at defendant Crittenton 
Hospital, where she was treated by defendant Dr. David Bauer.  An abdominal x-ray 
suggested the possibility of a partial small-bowel obstruction.  When Ligons refused to be 
admitted to the hospital, she was given antibiotics, treated for dehydration, and 
discharged with instructions to follow up with her treating physician the next day.  
Ligons did so and was immediately sent to the emergency room, where she was admitted.   
After extensive testing and the involvement of seven doctors, it was determined 
that surgery was necessary.  Ligons initially refused any surgery, but eventually agreed.  
Exploratory surgery performed on January 24, 2002, revealed a perforated colon, an 
inflamed pelvic mass, and an abscess.  The exploratory surgery further showed that 
Ligons had an advanced form of liver failure and that her liver had become hard and 
rocklike in appearance.  Ligons had been an alcoholic for more than 30 years and 
suffered from acute cirrhosis with ascites, alcoholic pancreatitis, alcoholic hepatitis, 
coagulopathy, diverticulosis coli, and colon polyps.  Removal of her colon was 
                                              
1 The physician who performed the colonoscopy is no longer a party to this suit. 
 
 
 
3
impossible because of these preexisting conditions.  Ligons never recovered from the 
surgery and died on January 29, 2002.     
Plaintiff was appointed personal representative of Ligon’s estate on February 22, 
2005, and delivered to defendants a notice of intent to sue2 (NOI) on June 8, 2005.  On 
October 21, 2005, plaintiff delivered a supplemental NOI providing more detail regarding 
proximate cause.  He filed a complaint in the Oakland Circuit Court on April 7, 2006, 
accompanied by two AOMs.   
The first AOM, signed March 8, 2005, was executed by Dr. George Sternbach, an 
emergency-medicine specialist.  Although the AOM contained 23 paragraphs regarding 
the manner in which the standard of care had been breached, only two of those 
paragraphs pertained specifically to this case:   
v. [The failure to a]dmit the patient to the hospital on January 22, 
2002. 
w. [The failure to o]btain appropriate consults on January 22, 2002. 
Regarding the manner in which these breaches were the proximate cause of the injury, 
the AOM provided, “As a direct and proximate cause of the imprudent acts and omission 
committed by the individuals identified herein, Edris Ligons, died.” 
 
The second AOM, signed on June 17, 2005, by Dr. Fred Thomas, did not address 
the required standard of practice or care, the breach of the standard of care, or the actions 
that should have been taken or omitted to comply with the standard of care.  Rather, the 
Thomas AOM addressed only the manner in which the breach of the standard of practice 
                                              
2 See MCL 600.2912b. 
 
 
 
4
or care was the proximate cause of the alleged injury: “It is my opinion that had the 
defendants admitted the patient to the hospital on January 22, 2002, and obtained the 
appropriate consults on January 22, 2002, as outlined in Dr. Sternbach’s affidavit[,] that 
Edris Ligons would not have died.” 
In March 2007, Bauer and defendant Rochester Emergency Group, P.C. (Bauer’s 
practice group) moved for summary disposition, arguing that plaintiff’s NOIs and AOMs 
did not comply with the governing statutes.  In April 2007, Crittenton concurred in the 
motion.  The trial court denied defendants’ motions on May 22, 2007. 
Bauer and Rochester Emergency applied for leave to file an interlocutory appeal, 
which the Court of Appeals initially denied.3  Bauer and Rochester Emergency then 
applied for leave to appeal in this Court and, in lieu of granting their application, we 
remanded the case to the Court of Appeals for consideration as on leave granted.4  The 
Court of Appeals later granted Crittenton’s application for leave to file a delayed cross-
appeal.5 
On remand from this Court, the Court of Appeals concluded that plaintiff’s two 
NOIs collectively satisfied the requirements of MCL 600.2912b.6  But a majority of the 
panel disagreed with the trial court’s ruling that the AOMs were sufficient, concluding 
                                              
3 Ligons v Crittenton Hosp, unpublished order of the Court of Appeals, entered January 
16, 2008 (Docket No. 278622). 
4 Ligons v Crittenton Hosp, 482 Mich 1005 (2008). 
5 Ligons v Crittenton Hosp, unpublished order of the Court of Appeals, entered March 2, 
2009 (Docket No. 288793). 
6 Ligons v Crittenton Hosp, 285 Mich App 337, 343-349; 776 NW2d 361 (2009). 
 
 
 
5
that neither AOM contained the required statement describing “[t]he manner in which the 
breach of the standard of practice or care was the proximate cause of the injury alleged in 
the notice.”7  The majority reasoned that “it is insufficient to merely allege that the 
defendant’s alleged negligence caused the injury,” and the AOMs “contain[ed] no 
explanation regarding how Dr. Bauer’s decision not to admit the decedent on January 22, 
2002, or obtain appropriate consultations was the proximate cause of the decedent’s 
death.”8  “[E]ven when read as a whole,” the AOMs “establish[ed] no connection 
between the purpose of the consultations, or what condition they might have revealed, 
and the cause of the decedent’s death,” nor did they explain how a one-day delay in 
admitting Ligons resulted in death rather than recovery.9 
Recognizing that the defective AOMs required dismissal of the case under 
Kirkaldy v Rim,10 the Court of Appeals further held that dismissal in this case had to be 
with prejudice.11  The Court of Appeals reasoned that, although filing a complaint and an 
AOM tolls the statutory limitations period pursuant to MCL 600.5856(a) until the AOM 
                                              
7 MCL 600.2912d(1)(d); Ligons, 285 Mich App at 349-351.  The Court of Appeals partial 
dissent would have found the AOMs sufficient to comply with MCL 600.2912d, but 
acknowledged that the AOMs did not specify how the failure to admit Ligons to the 
hospital and obtain the appropriate consults on January 22, 2002, caused Ligons’s death 
or how taking these actions could have prevented her death eight days later. Ligons, 285 
Mich App at 360-361 (FITZGERALD, J., concurring in part and dissenting in part).  
8 Id. at 350 (majority opinion), citing Roberts v Mecosta Co Gen Hosp (After Remand), 
470 Mich 679, 699 n 16; 684 NW2d 711 (2004). 
9 Ligons, 285 Mich App at 350. 
10 Kirkaldy v Rim, 478 Mich 581; 734 NW2d 201 (2007). 
11 Ligons, 285 Mich App at 354. 
 
 
 
6
is successfully challenged,12 tolling was unavailable here because plaintiff had not filed 
his complaint within the limitations period.  Plaintiff filed his complaint after the 
limitations period expired, but within the saving period afforded him as a personal 
representative under MCL 600.5852.  Under Waltz v Wyse,13 statutes that toll periods of 
limitations or statutes of repose, such as MCL 600.5856(a), do not toll saving 
provisions.14  The Court of Appeals concluded that no tolled time remained during which 
plaintiff could refile his suit after defendants successfully challenged his AOMs.  Thus, 
dismissal with prejudice was required on statute-of limitations-grounds.15  
Finally, the Court of Appeals rejected plaintiff’s argument that he should be 
permitted to amend his defective AOMs under the then existing version of MCR 
2.118(A), which permitted the amendment of “pleadings.”  The Court noted that the term 
“pleading” was restrictively defined by MCR 2.110(A) to include only complaints, cross-
claims, counterclaims, third-party complaints, answers to any of these documents, and 
replies to those answers.  This list does not include “mandatory attachments” such as 
AOMs.16  Finding no “positive authority suggesting that an affidavit of merit may be 
amended pursuant to MCR 2.118(A),” the Court concluded that “the only permissible 
remedy for a defective affidavit of merit is the one prescribed in Kirkaldy, which is 
                                              
12 Id. at 353-354, citing Kirkaldy, 478 Mich at 585-586. 
13  Waltz v Wyse, 469 Mich 642; 677 NW2d 813 (2004). 
14 Ligons, 285 Mich App at 352, 354. 
15 Id. at 354. 
16 Id. at 355. 
 
 
 
7
dismissal.”17  Accordingly, the Court of Appeals reversed the trial court and remanded 
the case for entry of an order of dismissal with prejudice.18 
Plaintiff applied to this Court for leave to appeal the Court of Appeals’ decision.  
We granted leave and directed the parties to address the following issues: “(1) whether 
the plaintiff may amend his affidavits of merit in light of Bush v Shabahang, 484 Mich 
156 [772 NW2d 272] (2009), and/or MCL 600.2301, and (2) whether the recent 
amendment of MCR 2.118 applies to the plaintiff’s affidavits of merit.”19 
II.  STANDARD OF REVIEW 
We review de novo a trial court’s ruling on a motion for summary disposition.20  
This case involves questions of statutory interpretation, which we also review de novo.21  
We interpret court rules using the same principles that govern the interpretation of 
statutes.22  Our goal when interpreting and applying statutes or court rules is to give effect 
to the plain meaning of the text.  If the text is unambiguous, we apply the language as 
written without construction or interpretation.23 
                                              
17 Id. 
18 Id. at 356. 
19 Ligons v Crittenton Hosp, 486 Mich 977 (2010). 
20 Haynes v Neshewat, 477 Mich 29, 34; 729 NW2d 488 (2007). 
21 Id. 
22 Marketos v American Employers Ins Co, 465 Mich 407, 412-413; 633 NW2d 371 
(2001). 
23 See Haynes, 477 Mich at 35; Marketos, 465 Mich at 413. 
 
 
 
8
III.  ANALYSIS 
A.  INTERPRETATION AND APPLICATION OF MCL 600.2912d 
MCL 600.2912d was enacted in 1986 and amended in 1993 as an element of broad 
tort reforms established by the Legislature.24  In part, the legislation placed “enhanced 
responsibilities” on medical malpractice plaintiffs.25  MCL 600.2912d(1) requires the 
following: 
Subject to subsection (2), the plaintiff in an action alleging medical 
malpractice or, if the plaintiff is represented by an attorney, the plaintiff’s 
attorney shall file with the complaint an affidavit of merit signed by a 
health professional who the plaintiff’s attorney reasonably believes meets 
the requirements for an expert witness under [MCL 600.2169].[26]  The 
affidavit of merit shall certify that the health professional has reviewed the 
notice and all medical records supplied to him or her by the plaintiff’s 
attorney concerning the allegations contained in the notice and shall 
contain a statement of each of the following: 
(a) The applicable standard of practice or care. 
(b) The health professional’s opinion that the applicable standard of 
practice or care was breached by the health professional or health facility 
receiving the notice. 
(c) The actions that should have been taken or omitted by the health 
professional or health facility in order to have complied with the applicable 
standard of practice or care. 
                                              
24 1986 PA 178; 1993 PA 78; see Scarsella v Pollak, 461 Mich 547, 548; 607 NW2d 711 
(2000); Solowy v Oakwood Hosp Corp, 454 Mich 214, 228; 561 NW2d 843 (1997). 
25 Solowy, 454 Mich at 228. 
26 MCL 600.2169 governs the qualifications of expert witnesses in medical malpractice 
actions. 
 
 
 
9
(d) The manner in which the breach of the standard of practice or 
care was the proximate cause of the injury alleged in the notice.  [Emphasis 
added.] 
MCL 600.2912d(2) and (3) extend the time during which an AOM may be filed under 
certain circumstances: 
(2) Upon motion of a party for good cause shown, the court in which 
the complaint is filed may grant the plaintiff or, if the plaintiff is 
represented by an attorney, the plaintiff’s attorney an additional 28 days in 
which to file the affidavit required under subsection (1). 
(3) If the defendant in an action alleging medical malpractice fails to 
allow access to medical records within the time period set forth in [MCL 
600.2912b(6)], the affidavit required under subsection (1) may be filed 
within 91 days after the filing of the complaint. 
In Scarsella v Pollak,27 this Court addressed the consequences of a plaintiff’s 
failure to file an AOM with the complaint as required by the statute.  We stressed the 
Legislature’s “‘mandatory and imperative’” language: 28 MCL 600.2912d(1) requires that 
a plaintiff “shall file with the complaint an affidavit of merit . . . .”29  In light of this 
legislative requirement, we held that “‘for statute of limitations purposes in a medical 
malpractice case, the mere tendering of a complaint without the required affidavit of 
merit is insufficient to commence the lawsuit.’”30  We rejected the plaintiff’s argument 
that he should have been permitted to amend his complaint by appending an untimely 
                                              
27 Scarsella, 461 Mich 547. 
28 Scarsella, 461 Mich at 549, quoting Scarsella v Pollak, 232 Mich App 61, 64; 591 
NW2d 257 (1998). 
29 Emphasis added. 
30 Scarsella, 461 Mich at 549, quoting Scarsella, 232 Mich App at 64. 
 
 
 
10
AOM, which would have been related back to the time the complaint was filed under 
MCR 2.118(D),31 because permitting such amendment would have “‘effectively 
repeal[ed] the statutory affidavit of merit requirement’”:32 
 
“[M]edical malpractice plaintiffs could routinely file their 
complaints without an affidavit of merit, in contravention of the court rule 
and the statutory requirement, and ‘amend’ by supplementing the filing 
with an affidavit at some later date.  This, of course, completely subverts 
the requirement of MCL 600.2912d(1) . . . that the plaintiff ‘shall file with 
the complaint an affidavit of merit,’ as well as the legislative remedy of 
MCL 600.2912d(2) . . . , allowing a twenty-eight-day extension in instances 
where an affidavit cannot accompany the complaint.”[33] 
In other words, Scarsella established that, when a plaintiff “wholly omits to file 
the affidavit required by MCL 600.2912d(1),” “the filing of the complaint is ineffective, 
and does not work a tolling of the applicable period of limitation.”34  When the untolled 
period of limitations expires before the plaintiff files a complaint accompanied by an 
AOM, the case must be dismissed with prejudice on statute-of-limitations grounds.35  
                                              
31 At the time Scarsella was decided, MCR 2.118(D) provided: 
Except to demand a trial by jury under MCR 2.508, an amendment 
relates back to the date of the original pleading if the claim or defense 
asserted in the amended pleading arose out of the conduct, transaction, or 
occurrence set forth, or attempted to be set forth, in the original pleading. 
32 Scarsella, 461 Mich at 550, quoting Scarsella, 232 Mich App at 65. 
33 Scarsella, 461 Mich at 550, quoting Scarsella, 232 Mich App at 65. 
34 Scarsella, 461 Mich at 553. 
35 Id. at 551-552. 
 
 
 
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Dismissal without prejudice is proper, however, if the untolled limitations period has not 
yet expired.36   
The issue whether a timely filed yet defective AOM tolled the limitations period 
was resolved in Kirkaldy.  Kirkaldy observed that, under MCL 600.5856(a),37 MCL 
600.2912d, and Scarsella, “the period of limitations is tolled when a complaint and 
affidavit of merit are filed and served on the defendant.”38  Distinguishing a wholly 
absent AOM from a potentially defective but timely filed AOM, we stressed the holding 
in Saffian v Simmons39 that “‘when an affidavit is filed, it is presumed valid.  It is only in 
subsequent judicial proceedings that the presumption can be rebutted.’”40  Accordingly, 
Kirkaldy held: 
[A] complaint and affidavit of merit toll the period of limitations 
until the validity of the affidavit is successfully challenged in “subsequent 
judicial proceedings.”  Only a successful challenge will cause the affidavit 
to lose its presumption of validity and cause the period of limitations to 
resume running. 
                                              
36 Id. (discussing the result in Gregory v Heritage Hosp, decided sub nom Dorris v 
Detroit Osteopathic Hosp Corp, 460 Mich 26; 594 NW2d 455 [1999]).  
37 MCL 600.5856 provides, in pertinent part: 
The statutes of limitations or repose are tolled in any of the 
following circumstances: 
(a) At the time the complaint is filed, if a copy of the summons and 
complaint are served on the defendant within the time set forth in the 
supreme court rules. 
38 Kirkaldy, 478 Mich at 585. 
39 Saffian v Simmons, 477 Mich 8; 727 NW2d 132 (2007). 
40 Kirkaldy, 478 Mich at 586, quoting Saffian, 477 Mich at 13. 
 
 
 
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Thus, if the defendant believes that an affidavit is deficient, the 
defendant must challenge the affidavit.  If that challenge is successful, the 
proper remedy is dismissal without prejudice.  Scarsella, [461 Mich] at 
551-552.  The plaintiff would then have whatever time remains in the 
period of limitations within which to file a complaint accompanied by a 
conforming affidavit of merit.[41] 
In Waltz, this Court clarified that MCL 600.5856, by its terms, tolls only periods 
of limitations or statutes of repose.42  A saving statute is neither a statute of limitations 
providing a limitations period nor a statute of repose; rather, it is “an ‘exception to the 
statute of limitations’” that allows “commencement of a wrongful death action as many 
as three years after the applicable statute of limitations has expired.”43  In other words, 
once the limitations period has run, tolling is no longer available, even if a saving statute 
would still allow commencement of the action.   
Read together, the cases establish four points necessary to resolving the case 
currently before us.  First, a plaintiff’s failure to file a timely AOM or to file a timely 
AOM that satisfies the requirements of MCL 600.2912d(1) generally results in the 
dismissal of the case.44  Second, that dismissal must be without prejudice unless other 
                                              
41 Kirkaldy, 478 Mich at 586. 
42 Waltz, 469 Mich at 650. 
43 Id. at 650-651, quoting Lindsey v Harper Hosp, 455 Mich 56, 65; 564 NW2d 861 
(1997); see also Miller v Mercy Mem Hosp, 466 Mich 196, 202; 644 NW2d 730 (2002) 
(“[MCL 600.5852] is a saving statute, not a statute of limitations.”). 
44 Although Justice CAVANAGH discusses Bush in his dissent, he does not address why 
dismissal was inappropriate here given Kirkaldy’s holding that dismissal is the 
appropriate remedy for a defective AOM.  
 
 
 
13
grounds for the dismissal exist, such as the expiration of the limitations period.45  Third, 
the timely filing of a defective AOM with the complaint tolls the limitations period unless 
                                              
45 Regardless of the fact that a provision for “mandatory dismissal with prejudice” is 
unnecessary in MCL 600.2912(d) because the statute of limitations necessitates 
dismissal, Justice HATHAWAY’s dissent proceeds with a misguided and fruitless search 
for legislative direction that a defective AOM requires “mandatory dismissal with 
prejudice.”  Unsurprisingly, she finds no such mandate, concluding instead that the 
Legislature rejected “mandatory dismissal” in light of its interpretation of a provision of 
the initial notice legislation that the Legislature never adopted.  
Although “actions of the Legislature in considering various alternatives in 
language in statutory provisions before settling on the language actually enacted” may 
constitute a legitimate form of legislative history, In re Certified Question from the 
United States Court of Appeals for the Sixth Circuit, 468 Mich 109, 115 n 5; 659 NW2d 
597 (2003), Justice HATHAWAY’s use of it here exemplifies the shortcomings inherent in 
that approach.  To reasonably discern legislative intent from rejected language, the 
rejected provision should be considered as a whole, rather than piecemeal as Justice 
HATHAWAY does by only looking at the first sentence of the provision.  The full 
provision stated: 
 
Except as otherwise provided in this subsection, in an action alleging 
medical malpractice, the court shall dismiss a claim not included in the 
notice required under [MCL 600.2912f].  This subsection does not apply to 
a claim that results from previously unknown information gathered during 
discovery.  [Format altered from strikethrough/insert format to show 
language as proposed.] 
On this same issue, Justice MARKMAN observed the following in Bush: 
As an initial matter, this seems entirely unrelated to the statute of 
limitations under which dismissal is granted.  The Legislature’s rejection of 
an unrelated provision can hardly be used to alter the clear meaning of a 
statute.  It seems far more reasonable to conclude that the Legislature 
rejected this provision in favor of [MCL 600.2912b(3)], which provides for 
similar treatment of the same subject matter: undiscovered claims. . . .  
How can [Justice HATHAWAY] draw an informed conclusion concerning 
legislative history from a provision never enacted without even considering 
a provision that has been enacted and actually substituted for the never-
 
 
 
 
14
and until the court finds the AOM defective.  Fourth, only limitations periods may be 
tolled; the timely filing of a defective AOM cannot toll a saving period.46 
B.  THE AFFIDAVITS OF MERIT WERE INSUFFICIENT 
As noted in part III(A), MCL 600.2912d(1) sets forth several requirements for 
affidavits of merit: (1) a certification that the health professional has reviewed the notice 
and all medical records supplied to him or her by the plaintiff’s attorney concerning the 
allegations contained in the notice, (2) the applicable standard of practice or care, (3) the 
health professional’s opinion that the applicable standard of practice or care was breached 
by the health professional or health facility receiving the notice, (4) the actions that 
should have been taken or omitted by the health professional or health facility in order to 
have complied with the applicable standard of practice or care, and (5) the manner in 
which the breach of the standard of practice or care was the proximate cause of the injury 
alleged in the notice.  The failure to include any of the required information renders the 
affidavit of merit insufficient. 
                                              
enacted provision?  [Bush, 484 Mich at 203-204 (MARKMAN, J., 
dissenting).] 
46 We decline plaintiff’s invitation to overrule the prior decisions of this Court instead of 
adhering to the doctrine of stare decisis.  “Stare decisis means ‘To abide by, or adhere to, 
decided cases.’”  Robinson v Detroit, 462 Mich 439, 463 n 20; 613 NW2d 307 (2000), 
quoting Black’s Law Dictionary (rev 4th ed), p 1577.  As both this Court and the United 
States Supreme Court have recognized, “[s]tare decisis is generally ‘the preferred course 
because it promotes the evenhanded, predictable, and consistent development of legal 
principles, fosters reliance on judicial decisions, and contributes to the actual and 
perceived integrity of the judicial process.’”  Robinson, 462 Mich at 463, quoting Hohn v 
United States, 524 US 236, 251; 118 S Ct 1969; 141 L Ed 2d 242 (1998).  Plaintiff has 
not argued why we should veer away from the stare decisis course, and we decline to 
revisit the body of caselaw involved here. 
 
 
 
15
Plaintiff’s AOMs failed to provide any statement of the manner in which the 
breach of the standard of care was the proximate cause of the injury alleged.  Dr. George 
Sternbach’s AOM provided only that “[a]s a direct and proximate cause of the imprudent 
acts and omission committed by the individuals identified herein, Edris Ligons, died.”  
Dr. Fred Thomas’s AOM provided only: “It is my opinion that had the defendants 
admitted the patient to the hospital on January 22, 2002, and obtained the appropriate 
consults on January 22, 2002, as outlined in Dr. Sternbach’s affidavit that Edris Ligons 
would not have died.”47  We have often said that it is insufficient to simply state the result 
when required to state the manner in which there was a breach: The answer to “How was 
the standard of care breached?” is never “The standard of care was breached.”48  
Similarly, answering the question “How was the breach the proximate cause of the 
injury?” requires more than “The breach caused the injury.”  In other words, the “‘mere 
correlation between alleged malpractice and an injury is insufficient to show proximate 
cause.’”49  Contrary to the dissents’ conclusions, this analysis does not require a 
                                              
47 Notably, Dr. Thomas’s AOM did not include any statements regarding the applicable 
standard of practice or care, his opinion that the applicable standard of practice or care 
was breached by the health professional or health facility receiving the notice, or the 
actions that should have been taken or omitted by the health professional or health facility 
in order to have complied with the applicable standard of practice or care.  Therefore, 
regardless of his statement of proximate cause, Dr. Thomas’s AOM was statutorily 
deficient. 
48 See Roberts, 470 Mich at 696 n 14; Boodt v Borgess Med Ctr, 481 Mich 558, 560-561; 
751 NW2d 44 (2008). 
49 Swanson v Port Huron Hosp (On Remand), 290 Mich App 167, 176; ___ NW2d ___ 
(2010) (citation omitted). 
 
 
 
16
heightened level of specificity; rather, it simply gives meaning to the level of specificity 
required by the statute itself.  The Legislature requires a statement not just that a breach 
caused the injury, but the manner in which the breach caused the caused the injury.50 
In this case, even the Court of Appeals dissent acknowledged that the AOMs were 
silent regarding how the defendants’ actions or inactions caused Ligons’s death.  A 
statement answering how is precisely what MCL 600.2912d(1)(d) requires, and this case 
demonstrates the importance of that requirement.  Ligons’s colon was perforated by a 
doctor (who is not a defendant here) eight days before she went to the hospital.  She then 
refused to be admitted to the hospital, only to come back a day later, when the perforated 
                                              
50 We also note that the dissents’ interpretations render superfluous the words “manner in 
which” as used in MCL 600.2912d(1)(d).  Simply stated, the dissents do not read MCL 
600.2912d(1)(d) as requiring a statement of “[t]he manner in which the breach of the 
standard of practice or care was the proximate cause of the injury alleged in the notice.”  
Instead, the statute is read only to require a statement that “the breach of the standard of 
practice or care was the proximate cause of the injury alleged in the notice.”  Because the 
dissents’ reading of MCL 600.2912d(1)(d) renders the words “manner in which” 
meaningless, it must be rejected.  See Pittsfield Charter Twp v Washtenaw Co, 468 Mich 
702, 714; 664 NW2d 193 (2003); see also Grimes v Dep’t of Transp, 475 Mich 72, 89; 
715 NW2d 275 (2006).  Although Justice HATHAWAY insists that “[o]ur courts have 
consistently interpreted the word ‘manner’ . . . as allowing for a single word description 
such as ‘homicide,’ ‘suicide,’ or ‘accident,’” post at 6, it is noteworthy that she does not 
cite a single case that held that the requirement of MCL 600.2912d(1)(d) to state “[t]he 
manner in which the breach of the standard of practice or care was the proximate cause of 
the injury alleged in the notice” can be satisfied by a single word description such as 
“malpractice” or even by “a similarly succinct description such as ‘the malpractice 
caused the death,’” post at 7.  This is because no case has ever so held inasmuch as such a 
holding would be inconsistent with the explicit directive of MCL 600.2912d(1)(d) to state 
“[t]he manner in which the breach of the standard of practice or care was the proximate 
cause of the injury alleged in the notice.”  (Emphasis added.)  Merely stating that “the 
malpractice caused the death” does not explain the manner in which the malpractice 
caused the death. 
 
 
 
17
colon was discovered.  With so many different parties and procedures involved, as well 
as Ligons’s own medical history, plaintiff must state how defendants’ alleged negligence 
in not diagnosing the perforated colon one day earlier was the proximate cause of 
Ligons’s death.  Plaintiff failed to do so, as required by MCL 600.2912d(1)(d); therefore, 
the AOMs were statutorily deficient.51 
C.  A PLAINTIFF MAY NOT AMEND A DEFECTIVE AFFIDAVIT OF MERIT 
Plaintiff nonetheless argues that MCR 2.112, MCR 2.118, MCL 600.2301, and 
Bush v Shabahang,52 permit retroactive amendment of defective AOMs.  We are not 
persuaded that these authorities compel that conclusion, one that is directly contrary to 
the rules of Scarsella and Kirkaldy, which call for dismissal in the event of an absent or 
defective AOM.53 
                                              
51 Justice HATHAWAY argues that the statements contained in the NOI can satisfy the 
AOM requirements.  See post at 7-8.  This argument fails to appreciate, however, that 
MCL 600.2912d(1)(d) very clearly states that the AOM “shall contain a statement” 
regarding “[t]he manner in which the breach of the standard of practice or care was the 
proximate cause of the injury alleged in the notice.”  (Emphasis added.)  It does not state 
that either the NOI or the AOM shall contain such a statement; it states that the AOM 
shall contain such a statement.  Therefore, whether the NOI contains such a statement is 
irrelevant to the question whether the AOM contains the statements required by MCL 
600.2912d(1). 
52 Bush, 484 Mich 156. 
53 Contrary to Justice HATHAWAY’s contention, see post at 12-13, Kirkaldy is not 
significantly distinguishable from the instant case.  Kirkaldy held that the appropriate 
remedy for a defective AOM is dismissal.  The fact that the defects in the affidavits of 
merit are not identical does not change the fact that the appropriate remedy remains 
dismissal. 
 
 
 
18
1.  AN AFFIDAVIT OF MERIT IS NOT A “PLEADING” THAT MAY BE AMENDED 
UNDER THE APPLICABLE VERSION OF MCR 2.118 
Plaintiff urges that amendment should be permitted under the version of MCR 
2.118 in effect at the time this case was pending in the trial court.54  MCR 2.118 governs 
amended and supplemental pleadings.  Both the prior and current versions of MCR 
2.118(A)(1) permit a party to “amend a pleading once as a matter of course within 14 
days after being served with a responsive pleading by an adverse party . . . .”55  MCR 
2.118(A)(2) further provides that “[e]xcept as provided in subrule (A)(1), a party may 
amend a pleading only by leave of the court or by written consent of the adverse party.  
Leave shall be freely given when justice so requires.”  Former MCR 2.118(D), which 
governed the relation back of amendments, provided, “An amendment that adds a claim 
or a defense relates back to the date of the original pleading if the claim or defense 
asserted in the amended pleading arose out of the conduct, transaction, or occurrence set 
forth, or attempted to be set forth, in the original pleading.”56 
By its terms, former MCR 2.118 applied only to a “pleading.”  MCR 2.110(A) 
defines “pleading” for purposes of the Michigan Court Rules restrictively to include 
“only: (1) a complaint, (2) a cross-claim, (3) a counterclaim, (4) a third-party complaint, 
(5) an answer to a complaint, cross-claim, counterclaim, or third-party complaint, and (6) 
                                              
54 As discussed later in this opinion, MCR 2.112 and MCR 2.118 were amended, 
effective May 1, 2010.  485 Mich ___ (order entered February 16, 2010). 
55 This one-time, automatic ability to revise may be exercised “within 14 days after 
serving the pleading if it does not require a responsive pleading.”  MCR 2.118(A)(1). 
56 Former MCR 2.118(D) (version effective January 1, 2001, through April 30, 2010, see 
463 Mich at clvii [2000]; 485 Mich at ____ [order entered February 16, 2010]). 
 
 
 
19
a reply to an answer. No other form of pleading is allowed.”57  As with statutes, when a 
court rule “specifically defines a given term, that definition alone controls.”58  An AOM, 
even if required to be appended to a complaint, is not included in this restrictive 
definition of a “pleading.”  Plaintiff relies heavily on a statement in Barnett v Hidalgo,59 
which described an AOM as “part of the pleadings” in determining that an AOM is 
“generally admissible as an adoptive admission[.]”  But plaintiff fails to appreciate the 
context in which the statement was made: describing a document as “part” of the 
pleadings when addressing an evidentiary issue does not turn the document into a 
pleading for purposes of MCR 2.118(D) if it does not meet the definition in MCR 
2.110(A).60  Indeed, elsewhere Barnett clearly referred to the AOM as distinct from the 
complaint, stating that AOMs “are required to accompany a complaint . . . .”  Id. at 160.  
Under MCR 2.110(A)(1), for purposes of the court rules it is the “complaint” itself that 
                                              
57 MCR 2.110(A) (emphasis added; formatting altered). 
58 Haynes, 477 Mich at 35. 
59 Barnett v Hidalgo, 478 Mich 151, 161; 732 NW2d 472 (2007). 
60 Further, the Barnett Court’s conclusion that an AOM may be offered at trial as an 
admission was based on the following logic: an AOM is a “sworn statement” regarding 
the issues addressed and “by filing the affidavit of merit with the court, [a] plaintiff 
manifests ‘an adoption or belief in its truth.’”  Barnett, 478 Mich at 160-161, quoting 
MRE 801(d)(2)(B), which permits admission of “a statement of which the party has 
manifested an adoption or belief in its truth.”  Barnett also cited former MRPC 3.3(a)(4), 
which refered to a lawyer’s general duty to refrain from offering “evidence that the 
lawyer knows to be false.”  Id. at 161; see 488 Mich ___, ___ (order entered October 26, 
2010).  It supported this logic, in turn, not by characterizing an AOM as a pleading, but 
by reference to other cases permitting the introduction of third-party affidavits—without 
regard to whether they were filed with the pleadings—as adoptive admissions.  Id. at 161 
n 4. 
 
 
 
20
constitutes a “pleading,” not the complaint and any document accompanying it.  Barnett 
neither held nor relied on the premise that an AOM is a pleading for purposes of the rule 
permitting amendment of pleadings, MCR 2.118 
Plaintiff also argues that the Court’s opinion in Scarsella compels the conclusion 
that an AOM is a pleading.  He stresses the Scarsella Court’s holding that “‘the mere 
tendering of a complaint without the required affidavit of merit is insufficient to 
commence the lawsuit.’”61  Then plaintiff notes that, pursuant to MCL 600.1901, which 
applies generally to all civil actions, “[a] civil action is commenced by filing a complaint 
with the court.”  And he similarly notes that the general civil complaint tolling statute 
cited in Scarsella, MCL 600.5856(a), permits tolling “[a]t the time the complaint is 
filed . . . .”  Because Scarsella held that a medical malpractice action is not 
commenced—and tolling does not occur—if the complaint is not accompanied by an 
AOM, plaintiff reasons that, for Scarsella to be consistent with MCL 600.1901 and MCL 
600.5856(a), an AOM must be “part and parcel” of the complaint. 
But Scarsella, like Barnett, did not rule that an AOM is a complaint or is “part and 
parcel” of the complaint.  Rather, the Court consistently referred to the complaint and 
AOM as distinct documents.  For example, the Court noted that “‘medical malpractice 
plaintiffs must file more than a complaint; they “shall file with the complaint an affidavit 
of merit . . . .”’”62  Importantly, Scarsella clarified that commencement of a medical 
                                              
61 Scarsella, 461 Mich at 549, quoting Scarsella, 232 Mich App at 64. 
62 Scarsella, 461 Mich at 549, quoting Scarsella, 232 Mich App at 64, quoting MCL 
600.2912d(1) (emphasis added). 
 
 
 
21
malpractice action is not governed solely by the general statutes applicable to civil suits.  
Rather, medical malpractice suits are governed in detail by specific statutes unique to this 
area of law.  In contrast to the generic rule that a civil action may be commenced through 
the mere filing of a complaint, MCL 600.2912b(1) establishes that, generally, “a person 
shall not commence an action alleging medical malpractice . . . unless the person has 
given the [defendants] written notice under this section not less than 182 days before the 
action is commenced.”63  Similarly, as Scarsella held, pursuant to MCL 600.2912d(1) a 
medical malpractice claimant must file not just a complaint, but “shall file with the 
complaint an affidavit of merit . . . .”64  A defendant, moreover, is not simply required to 
file an answer to the complaint, but must also file an affidavit of meritorious defense—
the counterpart to a plaintiff’s AOM—within 91 days after the plaintiff files an AOM.65 
These specific statutes governing medical malpractice actions, which “appl[y] to 
the more narrow realm of circumstances,” prevail over the more general rules applicable 
to all civil actions.66  Accordingly, it does not necessarily follow that, simply because 
other civil plaintiffs may commence suit by filing a complaint, an AOM is a complaint—
                                              
63 And see Boodt, 481 Mich at 562-563, which observed that a plaintiff “cannot 
commence an action before he or she files a notice of intent that contains all the 
information required under [MCL 600.2912b(4)]” and that, if the plaintiff fails to do so, a 
subsequently filed complaint and affidavit of merit do not toll the period of limitations. 
64 Emphasis added. 
65 MCL 600.2912e(1).  Instead of answering, a medical malpractice defendant also has a 
unique alternative option to “file with the court an affidavit certifying that he or she was 
not involved, either directly or indirectly, in the occurrence alleged in the action.”  MCL 
600.2912c(1). 
66 Miller v Allstate Ins Co, 481 Mich 601, 613; 751 NW2d 463 (2008). 
 
 
 
22
or is part and parcel of a complaint—particularly for purposes of applying the Michigan 
Court Rules.67   
Permitting amendment of a deficient AOM also runs directly counter to the 
statutes governing medical malpractice suits, particularly MCL 600.2912d.  By its terms, 
MCL 600.2912d requires that a plaintiff obtain a qualified expert willing to review the 
medical records and certify that the claim has merit because, in the expert’s opinion, each 
defendant breached the applicable standard of practice or care, there were actions the 
defendant should have taken or omitted in order to comply with the standard, and the 
breach was the proximate cause of the injury alleged in the presuit notice.68  Consistently 
with its purpose to certify merit at the outset of the case, MCL 600.2912d(1) directs that 
the plaintiff “shall file” the AOM “with the complaint.”  If the plaintiff is unable to 
comply with this mandate, the statute provides two alternatives for recourse: MCL 
600.2912d(2) permits the court to grant an additional 28 days in which to file the AOM 
“[u]pon motion of a party for good cause shown,” and MCL 600.2912d(3) affords the 
plaintiff “91 days after the filing of the complaint” to file the AOM if the defendant failed 
“to allow access to medical records within the time period set forth in [MCL 
600.2912b(6)].”   
                                              
67 Plaintiff also cites Jackson v Detroit Med Ctr, 278 Mich App 532, 543-544; 753 NW2d 
635 (2008), in which the Court of Appeals held that the trial court had discretion to 
decide whether an AOM could be amended under MCR 2.118(A).  The Jackson plaintiff 
sought to amend an AOM that was sufficient under MCL 600.2912d(1) in order to assert 
liability under new theories.  Id.  With regard to deficient AOMs such as those at issue 
here, Jackson reiterated that, under Kirkaldy and Scarsella, the proper remedy is 
dismissal.  Id. at 543. 
68 See MCL 600.2912d(1); Solowy, 454 Mich at 228. 
 
 
 
23
Accordingly, the statute clearly conveys that the AOM must be provided within 
the relevant time frames.  For this reason, permitting a plaintiff to correct deficiencies in 
the AOM through amendment as a matter of course within 14 days after service of a 
responsive pleading, MCR 2.118(A)(1), and indefinitely thereafter by leave of the court 
or consent of the adverse party, MCR 2.118(A)(2), would directly conflict with the 
legislative remedies provided in MCL 600.2912d(2) and (3), which allow a plaintiff who 
is unable to submit a conforming AOM with the complaint an additional 28 or 91 days, 
respectively, to complete and submit the AOM.  Just as the Scarsella Court reasoned in 
rejecting retroactive “amendment” of untimely AOMs under MCR 2.118, permitting 
amendment of a deficient AOM would similarly subvert the AOM statute by allowing 
plaintiffs to routinely file complaints without conforming AOMs.69   
Because permitting amendment of a defective AOM runs counter to the 
established statutes, court rules, and cases governing this area of law, we hold that a 
plaintiff may not amend a deficient AOM under the version of MCR 2.118 in effect 
during the pendency of this suit in the trial court.   
2.  MCL 600.2301 AND BUSH v SHABAHANG DO NOT AUTHORIZE 
AMENDMENT OF AN AFFIDAVIT OF MERIT 
Next, plaintiff urges that we permit amendment of deficient AOMs under MCL 
600.2301 and this Court’s 2009 decision in Bush.70  But retroactive amendment of a 
deficient AOM has never been authorized under any court rule or statute, and as 
                                              
69 Compare Scarsella, 461 Mich at 550. 
70 Bush, 484 Mich 156. 
 
 
 
24
explained in part III(C)(1), would actually be contrary to the specific statutory scheme 
governing medical malpractice actions.  This Court has long recognized that an 
attachment to a complaint or pleading is neither a “process” nor a “proceeding” under 
MCL 600.2301.71  In fact, this Court noted in 1892 that there was no statutory support for 
allowing amendment of an affidavit on the ground that it was a process or a proceeding:   
 
There is no statute now in force permitting amendments to 
attachment affidavits, and such amendments have never been deemed 
admissible under [How Stat] 7631, which provides that “the court in which 
                                              
71 Even if an affidavit of merit is part of a “proceeding” and subject to amendment under 
MCL 600.2301, Bush held that MCL 600.2301 requires an initial good-faith attempt to 
comply with the statutory requirements.  Plaintiff did not do so in this case.  In Bush, 484 
Mich at 183-184, the Court held that the defendant’s response to the plaintiff’s NOI, 
stating “‘the current medical condition of Gary Bush was not in any way caused or 
contributed by the activities of Dr. Shabahang,’” was “utterly lacking in a good-faith 
attempt to comply.”  The defendant’s statement demonstrated a lack of a good-faith 
attempt to comply because it merely stated in a conclusory fashion that the defendant’s 
alleged negligence did not cause the plaintiff’s injury.  Indeed, every justice in Bush 
agreed on this point.  See id. at 182-184; id. at 205-206 (MARKMAN, J., dissenting).  
Similarly, plaintiff’s statement here demonstrated a lack of a good-faith attempt to 
comply because it merely stated in a conclusory fashion that defendants’ negligence 
caused Ligons’s death.  It did not at all explain the manner in which defendants’ 
negligence caused her death.  Therefore, we respectfully disagree with Justice 
CAVANAGH’s assertion that “the contents of the AOM do not evidence an utter lack of a 
good-faith attempt to comply with the proximate-causation requirement of MCL 
600.2912d(1)(d).”  Post at 6. 
 
Furthermore, contrary to Justice CAVANAGH’s contention, “defendant’s substantial 
rights would be affected by permitting” MCL 600.2301 to cure what he refers to as the 
“technical defect in the AOM . . . .”  Post at 7.  MCL 600.2912d(1)(d) very clearly states 
that a medical malpractice plaintiff “shall file with the complaint an affidavit of merit” 
and that this affidavit “shall contain a statement” regarding “[t]he manner in which the 
breach of the standard of practice or care was the proximate cause of the injury alleged in 
the notice.”  (Emphasis added.)  Allowing a medical malpractice plaintiff to proceed in an 
action against a defendant even though the plaintiff did not provide such an affidavit 
affects the defendant’s substantial right to have the law mean what it says. 
 
 
 
25
any action shall be pending shall have power to amend any process, 
pleading, or proceeding in such action, either in form or substance, for the 
furtherance of justice.[72]  
The Bush Court’s application of MCL 600.2301 to a medical malpractice NOI was 
rooted in the Legislature’s 2004 amendment of MCL 600.5856(c), the notice-tolling 
statute, and does not apply to AOMs.  Unlike NOIs, which give notice to defendants, 
AOMs are meant to weed out frivolous cases before they are ever filed.  Applying Bush 
beyond the scope of the 2004 amendment of MCL 600.5856(c) and NOIs to AOMs 
would be an unwarranted expansion of its focus on the notice-tolling statute, would free 
the opinion from its statutory moorings, would frustrate the purpose of the AOM 
requirement, and would create unnecessary conflict with existing caselaw, such as 
Kirkaldy, which Bush did not overrule.  We therefore decline to apply the rationale of 
Bush beyond its limited statutory focus. 
3.  THE NEW VERSIONS OF MCR 2.112 AND MCR 2.118 
ARE NOT APPLICABLE 
Finally, we address plaintiff’s argument that he should now be permitted to amend 
his AOMs in light of the 2010 amendments of MCR 2.112 and MCR 2.118.  In addition 
to mandating that a party challenge an allegedly defective AOM or affidavit of 
meritorious defense within 63 days of service, MCR 2.112(L)(2)(b) now states, “An 
affidavit of merit or meritorious defense may be amended in accordance with the terms 
and conditions set forth in MCR 2.118 and MCL 600.2301.”  In turn, MCR 2.118(D) now 
states, in relevant part, “In a medical malpractice action, an amendment of an affidavit of 
                                              
72 Freer v White, 91 Mich 74, 76; 51 NW 807 (1892). 
 
 
 
26
merit or affidavit of meritorious defense relates back to the date of the original filing of 
the affidavit.”73  The February 16, 2010, order adopting the amendments unequivocally 
stated that they became effective May 1, 2010, long after the complaint and the AOMs in 
this case were filed and, indeed, after the Court of Appeals resolved the case and 
plaintiff’s application for leave to appeal was filed in this Court.74  Because this Court 
explicitly ordered that the amended rules have prospective effect, we will not apply the 
rules retroactively at plaintiff’s request.  Moreover, as defendants argue, full retroactive 
application of the rules is impossible at this late stage and would result in prejudice to 
defendants; defendants cannot go back in time and comply with the new requirement that, 
to challenge an AOM at all, they must do so within 63 days of service.  Accordingly, 
retroactive application of the rules would render defendants’ challenge to the AOMs 
ineffective and afford them no opportunity to renew their arguments concerning their 
deficiency or to oppose any motion plaintiff might bring for amendment at the court’s 
discretion under MCR 2.118(A)(2).  A newly adopted court rule will not be applied to 
pending actions if a “party acts, or fails to act, in reliance on the prior rules and the 
party’s action or inaction has consequences under the new rules that were not present 
under the old rules.”75  In other words, amended court rules will not apply retroactively if 
                                              
73 The substance of the amendments is not at issue here.   
74 See Ligons, 486 Mich at 978 (CORRIGAN, J., dissenting in part).  
75 Reitmeyer v Schultz Equip & Parts Co, Inc, 237 Mich App 332, 337; 602 NW2d 596 
(1999) (quotation marks and citation omitted). 
 
 
 
27
compliance with the newly prescribed time limits is impossible.76  We therefore decline 
to apply the amended versions of MCR 2.112 and MCR 2.118 here. 
D.  DISMISSAL WITH PREJUDICE WAS REQUIRED 
Plaintiff’s case was dismissed with prejudice because the two-year statutory 
limitations period provided in MCL 600.5805(6) for his medical malpractice action 
expired before his AOMs were deemed defective; therefore, no tolling was available to 
him upon his filing the complaint under MCL 600.5856(a).  The alleged malpractice by 
defendants occurred on January 22, 2002.  Accordingly, the two-year limitations period 
expired on January 22, 2004.  If the suit had been commenced before January 22, 2004, 
the limitations period would have been tolled when the complaint was filed with the 
accompanying AOMs.  But no suit was filed within the limitations period, so no tolling 
was available. 
Instead, plaintiff filed suit within the saving period afforded him under MCL 
600.5852, which permits the personal representative of the decedent’s estate to 
commence an action “at any time within 2 years after letters of authority are issued 
although the period of limitations has run” as long as commencement is “within 3 years 
after the period of limitations has run.”  Plaintiff was appointed personal representative 
on February 22, 2005.77  He had until January 22, 2007—three years after the two-year 
period of limitations expired on January 22, 2004—in which to file suit during the saving 
                                              
76 See Solosth v Pere Marquette R Co, 255 Mich 62, 66; 237 NW 554 (1931). 
77 Plaintiff is the second personal representative of Ligons’s estate.   
 
 
 
28
period.  He filed his complaint and AOMs on April 7, 2006.  Although plaintiff filed suit 
during the saving period, because the limitations period had expired, there was nothing 
left to toll under MCL 600.5856(a) when he filed the complaint even though it was 
accompanied by AOMs.  For these reasons, the Court of Appeals correctly dismissed 
plaintiff’s case with prejudice. 
IV.  CONCLUSION 
Pursuant to the plain and controlling language of MCR 2.110(A), the applicable 
version of MCR 2.118, MCL 600.5856, MCL 600.2912d, and this Court’s decisions in 
Scarsella, Kirkaldy, and Waltz, we hold that a defective AOM may not be retroactively 
amended and that the proper response to a defective AOM is dismissal.  Although the 
timely filing of a defective AOM tolls the limitations period until a court finds the AOM 
defective, an AOM filed during a saving period after the limitations period has expired 
tolls nothing, as the limitations period has run and the saving period may not be tolled.  In 
this case, because the limitations period had run before the complaint was filed, plaintiff 
cannot amend his defective AOMs retroactively. Given that the saving period has 
expired, plaintiff’s case had to be dismissed with prejudice.  The judgment of the Court 
of Appeals is affirmed.   
 
 
Brian K. Zahra 
 
Robert P. Young, Jr. 
 
Stephen J. Markman 
 
Mary Beth Kelly 
S T A T E  O F  M I C H I G A N 
 
SUPREME COURT 
 
 
DUJUAN LIGONS, Personal Representative 
of the Estate of EDRIS LIGONS, 
 
 
Plaintiff-Appellant, 
 
 
v 
No. 139978 
 
CRITTENTON HOSPITAL, a/k/a 
CRITTENTON HOSPITAL MEDICAL 
CENTER, DAVID BRUCE BAUER, M.D., 
and ROCHESTER EMERGENCY GROUP, 
P.C., 
 
 
 
Defendants-Appellees. 
 
 
 
CAVANAGH, J. (dissenting).  
I respectfully dissent from the majority’s decision to affirm the Court of Appeals’ 
judgment dismissing plaintiff’s case with prejudice.  In my view, MCL 600.2301 should 
apply when the contents of an affidavit of merit (AOM) are deficient.  Accordingly, I 
would remand this case to the trial court for consideration under MCL 600.2301.   
For the reasons stated in Justice MARILYN KELLY’s dissent in Roberts v Mecosta 
Co Gen Hosp (After Remand), 470 Mich 679, 702-714; 684 NW2d 711 (2004) (MARILYN 
KELLY, J., dissenting), I agree with Justice HATHAWAY’S conclusion in this case that a 
heightened level of specificity in the contents of an AOM is not required.  While Justice 
MARILYN KELLY’s dissent examined MCL 600.2912b, addressing the contents of a 
notice of intent to sue (NOI), I believe that her analysis is persuasive as it relates to the 
AOM statute, MCL 600.2912d.   
 
2
As the Roberts dissent explained, it is this Court’s duty to determine the 
Legislature’s intent, which begins with an examination of a statute’s language.  Roberts, 
470 Mich at 705 (MARILYN KELLY, J., dissenting).  Because the “Legislature knows what 
phrasing to use when it intends to require extensive detail,” it is noteworthy that the 
Legislature did not “explicitly mandate such specificity” in the AOM context.  Id. at 709.  
Specifically, like the NOI statute, MCL 600.2912d only requires a “statement” regarding 
the alleged manner in which the breach of the standard of practice or care was the 
proximate cause of the injury alleged in the notice.1  Thus, as Justice HATHAWAY notes, 
the AOM statute does not expressly require a heightened level of specificity, as do other 
statutes.  See Roberts, 470 Mich at 708-709 (MARILYN KELLY, J., dissenting) (examining 
other statutes that require “detailed,” “complete,” or “full” statements, or that require 
statements made “with specificity”).  Further, because the purpose of the AOM statute is 
to deter frivolous medical malpractice claims by requiring a certification that a claim is 
                                              
1 MCL 600.2912d(1) states in relevant part: 
[T]he plaintiff in an action alleging medical malpractice or, if the 
plaintiff is represented by an attorney, the plaintiff’s attorney shall file with 
the complaint an affidavit of merit signed by a health professional who the 
plaintiff’s attorney reasonably believes meets the requirements for an expert 
witness under [MCL 600.2169].  The affidavit of merit shall certify that the 
health professional has reviewed the notice and all medical records supplied 
to him or her by the plaintiff’s attorney concerning the allegations 
contained in the notice and shall contain a statement of each of the 
following: 
*   *   * 
(d) The manner in which the breach of the standard of practice or 
care was the proximate cause of the injury alleged in the notice. 
 
3
valid, a general assertion of the items required by the AOM statute is sufficient to lend 
professional credence to the claim’s legitimacy and thus is likely sufficient to meet the 
statute’s apparent intent.  See id. at 707-708.  Therefore, I agree with Justice HATHAWAY 
that a high level of specificity is not required in the AOM context.  
Nevertheless, assuming arguendo that the AOM2 in this case was deficient, I 
believe that MCL 600.23013 should apply to allow a cure of the alleged deficiency within 
the AOM. To begin with, applying MCL 600.2301 would not conflict with MCL 
600.2912d, when the latter is read as a whole.  Indeed, as recognized by Justice 
HATHAWAY, the AOM statute does not expressly provide a penalty for deficiencies 
within the contents of an AOM.  And, notably, the allowances of additional time to file 
an AOM in MCL 600.2912d(2) and (3) do not explicitly preclude amending or 
disregarding defects within the contents of an AOM.4  Instead, those provisions merely 
                                              
2 Although plaintiff filed two AOMs in this case, because I believe that, at a minimum, 
MCL 600.2301 would permit the alleged defects in Dr. George Sternbach’s AOM to be 
cured, I will refer to AOM in the singular.   
3 MCL 600.2301 provides: 
The court in which any action or proceeding is pending, has power 
to amend any process, pleading or proceeding in such action or proceeding, 
either in form or substance, for the furtherance of justice, on such terms as 
are just, at any time before judgment rendered therein.  The court at every 
stage of the action or proceeding shall disregard any error or defect in the 
proceedings which do not affect the substantial rights of the parties. 
 
4 MCL 600.2912d provides, in relevant part: 
(2) Upon motion of a party for good cause shown, the court in which 
the complaint is filed may grant the plaintiff or, if the plaintiff is 
represented by an attorney, the plaintiff’s attorney an additional 28 days in 
which to file the affidavit required under subsection (1). 
 
 
4
provide a plaintiff additional time in which to file the initial AOM and, thus, do not 
address curing an arguably defective AOM.  And while I continue to adhere to my 
position in Kirkaldy v Rim, 478 Mich 581, 586-587; 734 NW2d 201 (2007) (CAVANAGH, 
J., concurring), as Justice HATHAWAY suggests, allowing a defect within an AOM to be 
cured under MCL 600.2301 would simply provide an alternative remedy to that of 
Kirkaldy, in which the majority opined that the remedy for a successful challenge to a 
deficient AOM is dismissal without prejudice, id. at 586 (majority opinion).  
Accordingly, I believe that MCL 600.2301 should apply.5  
 
Notably, the aim of MCL 600.2301 is to “‘“abolish technical errors in proceedings 
and to have cases disposed of as nearly as possible in accordance with the substantial 
rights of the parties.”’”  Boodt v Borgess Med Ctr, 481 Mich 558, 569; 751 NW2d 44 
(2008) (CAVANAGH, J., dissenting), quoting Gratiot Lumber & Coal Co v Lubinski, 309 
Mich 662, 668-669; 16 NW2d 112 (1944).  And, by its terms, MCL 600.2301 applies to 
any “process” or “proceeding” before a court, allowing amendment, in either form or 
substance, at “any time” before judgment is rendered.   See, also, Bush v Shabahang, 484 
Mich 156, 176; 772 NW2d 272 (2009).  
                                              
(3) If the defendant in an action alleging medical malpractice fails to 
allow access to medical records within the time period set forth in [MCL 
600.2912b(6)], the affidavit required under subsection (1) may be filed 
within 91 days after the filing of the complaint. 
5 I disagree with the majority in this case that Kirkaldy provides the sole remedy for a 
defective AOM, given my belief that MCL 600.2301 provides an alternative remedy to 
the one posed by the majority in Kirkaldy, which, notably, did not cite or address the 
merits of applying MCL 600.2301. 
 
5
 
In this case, judgment had not yet been entered and, in my view, an AOM is part 
and parcel of a medical-malpractice “proceeding,” given that it must be filed with the 
medical-malpractice complaint.  See Black’s Law Dictionary (9th ed) (defining 
“proceeding” as including “[t]he regular and orderly progression of a lawsuit, including 
all acts and events between the time of commencement and the entry of judgment”; 
“[a]ny procedural means for seeking redress from a tribunal or agency”; and “[a]n act or 
step that is part of a larger action”); see, also, Bush, 484 Mich at 176-177; Boodt, 481 
Mich at 568 n 6 (CAVANAGH, J., dissenting).6  Further, because MCL 600.2301 permits 
amendment “either in form or substance,” amending the substance of an AOM to more 
clearly state the manner in which the breach of the standard of practice or care was the 
proximate cause of the injury is proper.  See Boodt, 481 Mich at 569 (CAVANAGH J., 
                                              
6 As I have recognized in the past, this Court has previously applied MCL 600.2301 or its 
predecessors to allow amendment of documents that fall under the category of a process 
or proceeding.  See Boodt, 481 Mich 567-572 (CAVANAGH, J., dissenting); Bush, 484 
Mich at 177 n 38.  For this reason I disagree with the majority’s suggestion that this 
Court has “long recognized” that an AOM cannot be amended under MCL 600.2301.  
Indeed, the only case that the majority cites for this position is Freer v White, 91 Mich 
74; 51 NW 807 (1892).  Yet Freer did not cite any Michigan authority for its assertion 
that amendments to “attachment affidavits” “have never been deemed admissible” under 
a predecessor of MCL 600.2301.  Id. at 76.  More importantly, however, Freer did not 
address the statute at issue in this case.  Instead, Freer involved an “attachment affidavit” 
in an attachment proceeding.  Id. (emphasis added).  See, generally, MCR 3.103 
(explaining the process for seeking a writ of attachment).  Thus, because Freer involved 
an attachment proceeding, its statements regarding the applicability of the predecessor of 
MCL 600.2301 it discussed, which, by its terms, only expressly involved attachment 
affidavits, should not be read as applying to all affidavits generally, especially when this 
Court has held that statutes such as the predecessors of MCL 600.2301 should be 
“liberally construed.”  See Beecher v Wayne Circuit Judges, 70 Mich 363, 367; 38 NW 
322 (1888).   
 
6
dissenting); Bush, 484 Mich at 177 (recognizing that MCL 600.2301 allows for 
amendment of errors in form or substance).   
 
Also, permitting amendment of a defective AOM would be “for the furtherance of 
justice,” consistent with MCL 600.2301.  As I explained in Boodt, justice is furthered by 
applying MCL 600.2301 in a case in which a statute operates as a “terminal trap” for the 
unwary when as here, defendants seek to avoid litigation of a potentially meritorious 
claim on the basis of a technical defect in an otherwise sufficient7 and timely filed AOM.  
See Boodt, 481 Mich at 569 (CAVANAGH, J., dissenting).  Additionally, when plaintiff’s 
AOM is read as a whole, the contents of the AOM do not evidence an utter lack of a 
good-faith attempt to comply with the proximate-causation requirement of MCL 
600.2912d(1)(d).8  Accordingly, even if plaintiff’s AOM were deficient, allowing the 
alleged defect to be cured under MCL 600.2301 would be in the furtherance of justice.  
See Bush, 484 Mich at 180-181.   
 
Further, I do not believe that defendants’ substantial rights would be affected by 
permitting MCL 600.2301 to cure the alleged defect in plaintiff’s AOM.  See Bush, 484 
Mich at 177-178.  Unlike an NOI, which is aimed at providing notice of a claim to a 
                                              
7 Notably, in this case, only the AOM’s statement regarding the manner in which the 
breach of the standard of practice or care was the proximate cause of the injury is at issue.  
8 Instead, the AOM in this case indicated that, in order to comply with the applicable 
standard of care, defendants should have admitted the decedent to the hospital on 
January 22, 2002, and obtained the appropriate consultations on that date and that, as a 
direct and proximate cause of defendants’ acts and omissions, the decedent died.  
Compare, Bush, 484 Mich at 178, 180 n 43, 182-183 (concluding that the defendant’s 
one-page blanket denial provided an example of a failure to demonstrate a good-faith 
attempt to comply with the content requirements of the NOI statute). 
 
7
defendant and promoting settlement, see Roberts, 470 Mich at 707-708 (MARILYN 
KELLY, J., dissenting), and Bush, 484 Mich at 174, the purpose of an AOM is to 
demonstrate that a valid claim exists.  Thus, because an AOM is not intended to provide 
details in an effort to give notice of an impending claim and to promote settlement, a 
stronger justification likely exists for allowing a minor defect in the contents of an AOM 
to be cured.  Stated another way, despite a technical defect in the AOM, a defendant 
would certainly be apprised of the fact that a health-care professional who had reviewed 
the plaintiff’s medical records believed that there was a valid claim, furthering the intent 
of the AOM statute.  And although a defendant is required to file an answer to a 
plaintiff’s complaint within 21 days after an AOM is filed, a defendant’s affidavit of 
meritorious defense is not dependent on the contents of a plaintiff’s AOM.  See MCL 
600.2912e; cf. MCL 600.2912b(7) (requiring a defendant to submit a written response to 
a plaintiff’s NOI).9  Thus, I would not hastily conclude that a defendant’s substantial 
rights would be affected by permitting any alleged defects to be cured under MCL 
600.2301.10   
                                              
9 In my view, any claim of prejudice to defendants’ rights rings hollow in this case.  Like 
the AOM statute, the NOI statute similarly requires a statement regarding proximate 
causation.  MCL 600.2912b(4)(e).  In this case, defendants cannot legitimately claim that 
they would be unfairly prejudiced by allowing the alleged defects in the AOM to be 
cured, given that plaintiff’s statement regarding proximate causation in the supplemental 
NOI was deemed sufficient by the Court of Appeals and defendants were served with 
plaintiff’s supplemental NOI before plaintiff filed the complaint and AOM. 
10 For the reasons stated in this dissent, I respectfully disagree with the majority’s 
conclusion that permitting a cure would affect defendants’ substantial rights.  See, also, 
Bush, 484 Mich at 178.  Further, I respectfully disagree with the majority’s suggestion 
that permitting a trial court to cure a technical defect within an AOM is erroneous.  In my 
view, the majority’s opinion effectively renders MCL 600.2301 nugatory. 
 
8
 
Accordingly, even assuming arguendo that the AOM was deficient in this case, 
because I believe that the alleged defect can be cured pursuant to MCL 600.2301, I would 
remand this case to the trial court for consideration under that statute.   
 
 
Michael F. Cavanagh 
 
Marilyn Kelly 
S T A T E  O F  M I C H I G A N 
 
SUPREME COURT 
 
 
DUJUAN LIGONS, Personal Representative 
of the Estate of EDRIS LIGONS,  
 
 
Plaintiff-Appellant, 
 
 
v 
No. 139978 
 
CRITTENTON HOSPITAL, a/k/a 
CRITTENTON HOSPITAL MEDICAL 
CENTER, DAVID BRUCE BAUER, M.D., 
and ROCHESTER EMERGENCY GROUP, 
P.C., 
 
 
 
Defendants-Appellees. 
 
 
 
HATHAWAY, J. (dissenting). 
 
I respectfully dissent from the majority’s decision to dismiss plaintiff’s medical 
malpractice action with prejudice.  The majority holds that plaintiff’s affidavits of merit 
(AOMs) were defective, that they cannot be amended pursuant to MCL 600.2301, and 
that plaintiff’s complaint must therefore be dismissed with prejudice.  The majority’s 
conclusions are erroneous because plaintiff’s AOMs were not defective and even in cases 
involving AOMs with content defects, MCL 600.2301 clearly provides relief.  Moreover, 
the plain language of the AOM statute, MCL 600.2912d(1), does not contemplate, let 
alone require, that a plaintiff’s complaint be dismissed with prejudice for defects 
contained in an AOM.  Thus, the majority’s decision ignores the plain language of the 
 
 
 
2
relevant statutes.  The majority abandons the rule of law and reaches its result by 
rewriting the applicable statutes.  Accordingly, I dissent.   
I.  THE REQUIREMENTS OF THE AOM STATUTE 
At issue is whether plaintiff’s AOMs met the requirements of MCL 600.2912d(1), 
the AOM statute.  To correctly resolve this issue, we must first examine the language of 
the AOM statute and determine its correct interpretation.  In examining this statute, we 
follow the established rules of statutory construction.  The purpose of statutory 
construction is to discern and give effect to the intent of the Legislature.1  In doing so, we 
first look to the actual language of the statute.2  If a statute is clear and unambiguous, it 
must be enforced as written and no further judicial construction is allowed.3  Simply 
stated, we must avoid a construction that would render any part of the statute nugatory,4 
and similarly, we are “not free to add language to a statute or to interpret a statute on the 
basis of this Court’s own sense of how the statute should have been written.”5  Further, a 
                                              
1 Potter v McLeary, 484 Mich 397, 410; 774 NW2d 1 (2009), citing Sun Valley Foods Co 
v Ward, 460 Mich 230, 236; 596 NW2d 119 (1999). 
2 Potter, 484 Mich at 410. 
3 Sun Valley, 460 Mich at 236. 
4 People v McGraw, 484 Mich 120, 126; 771 NW2d 655 (2009), citing Baker v Gen 
Motors Corp, 409 Mich 639, 665; 297 NW2d 387 (1980). 
5 Kirkaldy v Rim, 478 Mich 581, 587; 734 NW2d 201 (2007) (CAVANAGH, J., 
concurring). 
 
 
 
3
statute must be read as a whole,6 and while individual words and phrases are important, 
the words and phrases should be read in the context of the entire legislative scheme.7   
MCL 600.2912d, the AOM statute, provides in pertinent part: 
(1) Subject to subsection (2), the plaintiff in an action alleging 
medical malpractice or, if the plaintiff is represented by an attorney, the 
plaintiff’s attorney shall file with the complaint an affidavit of merit signed 
by a health professional who the plaintiff’s attorney reasonably believes 
meets the requirements for an expert witness under [MCL 600.2169].  The 
affidavit of merit shall certify that the health professional has reviewed the 
notice and all medical records supplied to him or her by the plaintiff’s 
attorney concerning the allegations contained in the notice and shall contain 
a statement of each of the following: 
(a) The applicable standard of practice or care. 
(b) The health professional’s opinion that the applicable standard of 
practice or care was breached by the health professional or health facility 
receiving the notice. 
(c) The actions that should have been taken or omitted by the health 
professional or health facility in order to have complied with the applicable 
standard of practice or care. 
(d) The manner in which the breach of the standard of practice or 
care was the proximate cause of the injury alleged in the notice.   
 
The majority focuses on the requirements of subdivision (d), which states that the 
AOM shall contain a statement of “[t]he manner in which the breach of the standard of 
practice or care was the proximate cause of the injury alleged in the notice.”  In this case, 
                                              
6 See Sun Valley, 460 Mich at 237. 
7 Herman v Berrien Co, 481 Mich 352, 366; 750 NW2d 570 (2008). 
 
 
 
4
plaintiff submitted two separate AOMs.8  The majority holds that these AOMs were 
deficient because they “failed to provide any statement of the manner in which the breach 
of the standard of care was the proximate cause of the injury alleged.”9  This conclusion 
is disingenuous because the plaintiff’s AOMs did contain statements regarding causation.  
The statements were just not made to the level of exacting detail that the majority asserts 
is required by the statute.  However, the majority’s interpretation of what is required by 
MCL 600.2912d, the AOM statute, is erroneous.        
In analyzing the AOM statute, we must be mindful that the Michigan Legislature 
has enacted many statutes requiring that a party detail certain facts or elements of a claim 
with varying levels of heightened specificity.  For example, the Legislature used the 
phrase “with specificity” in MCL 333.17015(10), MCL 333.22231(4), and MCL 
769.1a(8).  The phrase “stating specifically” was used in MCL 38.416 and MCL 
500.8133(3).  The Legislature mandated in MCL 38.14, MCL 125.1510(1),  MCL 
408.1027(2)(b),  MCL 462.319(1)(a), MCL 600.557b(2), and MCL 600.6461(2) that a 
“detailed statement” be made; required a “full statement” in MCL 224.25, MCL 
491.920(3), and MCL 500.424(2); required a “complete statement” in MCL 14.283(b) 
                                              
8 Plaintiff’s AOM containing a statement from Dr. Fred Thomas provided in pertinent 
part that “[i]t is my opinion that had the defendants admitted the patient to the hospital on 
January 22, 2002, and obtained the appropriate consults on January 22, 2002, as outlined 
in Dr. Sternbach’s affidavit that Edris Ligons would not have died.”  Plaintiff’s AOM 
containing a statement from Dr. George Sternbach provided in pertinent part that “[a]s a 
direct and proximate cause of the imprudent acts and omission committed by the 
individuals identified herein, Edris Ligons, died.” 
9 Ante at 15 (emphasis added). 
 
 
 
5
and MCL 462.2(2); and required a “full and complete statement” in MCL 247.172, MCL 
324.51904, and MCL 390.758.  
The Legislature chose not to incorporate any of these phrases heightening the level 
of specificity in the AOM statute.  If the Legislature had chosen to incorporate such 
qualifying language in MCL 600.2912d(1), then the majority might have a basis for its 
conclusion.  However, MCL 600.2912d(1) is silent concerning the level of specificity 
with which the information in an AOM must be conveyed.  Nothing in the plain language 
of this statute mandates the heightened level of specificity that the majority demands, and 
this Court is not free to add words or phrases to a statute.  Thus, the requirement that the 
AOM “shall contain a statement of each of the following” simply means what it says.10  
The statute requires that “a statement” must be made, not a “detailed statement,” “a 
complete statement,” or a “full explanatory statement.”  
Moreover, the majority distorts the word “manner” as used in MCL 
600.2912d(1)(d).11  The majority opines that the word “manner” requires a detailed 
statement of “how” the breach caused the injury:  
We have often said that it is insufficient to simply state the result 
when required to state the manner in which there was a breach: The answer 
to “How was the standard of care breached?” is never “The standard of care 
was breached.”  Similarly, answering the question “How was the breach 
                                              
10 MCL 600.2912d(1). 
11 MCL 600.2912d(1)(d) states, “The manner in which the breach of the standard of 
practice or care was the proximate cause of the injury alleged in the notice.”  (Emphasis 
added.) 
 
 
 
6
the proximate cause of the injury?” requires more than “The breach 
caused the injury.”[12]   
 
However, this conclusion is inconsistent with how the word “manner” has been 
interpreted in other statutes such as MCL 28.258(12)(b), MCL 52.202(1), and MCL 
52.205.  Our courts have consistently interpreted the word “manner” as used in relation to 
those statutes as allowing for a single word description such as “homicide,” “suicide,” or 
“accident.”  In People v Williams, the Court of Appeals wrote: 
Over the next two days Ashton’s condition continually deteriorated.  
Ashton died on November 10, 2003.  An autopsy revealed that the cause of 
death was loss of consciousness caused by brain swelling.  The Medical 
Examiner determined that Ashton had been violently shaken, causing his 
head to snap back and forth.  The Medical Examiner concluded that the 
manner of death was homicide.13 
 
See also, Maiden v Rozwood, 461 Mich 109, 115; 597 NW2d 817 (1999) (“[T]he 
‘manner of death was an accident.’”) (citation omitted); People v Bailey, 451 Mich 657, 
664; 549 NW2d 325 (1996) (“‘The manner of death is homicide.’”) (citation omitted); 
People v Schmitt, unpublished opinion per curiam of the Court of Appeals, issued July 
31, 2007 (Docket No. 264176), p 2 (ZAHRA, P.J., dissenting) (“The medical examiner 
determined the manner of Richard’s death to be a homicide . . . .”), rev’d 480 Mich 963 
(2007); and People v Small, unpublished opinion per curiam of the Court of Appeals, 
issued December 28, 1999 (Docket No. 205544), p 1 (“The assistant medical examiner 
                                              
12 Ante at 15 (second emphasis added). 
13 People v Williams, unpublished opinion per curiam of the Court of Appeals, issued 
November 29, 2005 (Docket No. 256123), p 2. 
 
 
 
7
testified that the cause of death was multiple gunshot wounds and that manner of death 
was homicide.”).   
Thus the use of the word “manner” in the AOM statute does not mandate a 
detailed description of how the breach caused the injury; rather the manner in which the 
breach was the proximate cause of the injury can be set forth in a similarly succinct 
description such as “the malpractice caused the death” or “the breaches of the standard of 
care caused the death,” or “the death was caused by the breaches of the standard of care.”  
Thus, all that MCL 600.2912d(1)(d) requires is a statement that the breach of the standard 
of care caused the result.  To require the parties to provide further description creates a 
requirement not found in the language of the statute.    
Moreover, the majority’s ruling transforms an AOM into something that it is not.  
The AOM statute is one part of a larger statutory scheme for malpractice claims, and it 
must be read in the context of that larger legislative scheme.  As set forth by the clear 
language of MCL 600.2912d(1), an AOM is designed only to act as certification that the 
claim is supported by the opinion of a qualified expert.  The statute states that the 
plaintiff “shall file . . . an affidavit of merit signed by a health professional who the 
plaintiff’s attorney reasonably believes meets the requirements for an expert witness . . . .  
The affidavit of merit shall certify that the health professional has reviewed the notice [of 
intent] . . . concerning the allegations contained in the notice . . . .”14  Thus, an AOM is 
intended to function as a certification that the allegations contained within the notice of 
                                              
14 MCL 600.2912d(1) (emphasis added). 
 
 
 
8
intent (NOI) are meritorious.  An AOM is filed with the complaint and is not the notice 
pleading.  The NOI is the notice pleading.  The AOM serves as certification that the 
allegations of the claim are meritorious, and its only role is to deter the filing of 
unsupported claims.  By failing to read the AOM statute in its entirety and in the context 
of the malpractice statutory scheme, the majority simply misconstrues the statute. 
The majority compounds its error by focusing solely on the statements made in the 
AOM, rather than reading the AOM in concert with the NOI, as contemplated by the 
AOM statute.  The AOM statute requires that “[t]he affidavit of merit shall certify that 
the health professional has reviewed the notice and all medical records supplied to him or 
her by the plaintiff’s attorney concerning the allegations contained in the notice . . . .”15  
As evidenced by this plain language, an AOM is not a standalone document.  Rather, it is 
to be read in concert with the NOI.  The statute requires that the expert review the NOI 
and certify that he or she supports allegations contained therein, and while the statute 
requires the expert to make a statement on proximate causation, it does not require that 
the expert repeat the contents of the NOI in the AOM.   
II.  THE SUFFICIENCY OF PLAINTIFF’S AFFIDAVITS OF MERIT 
In this case, the NOI set forth in detail the nature of the claim and how the 
plaintiff’s decedent, Edris Ligons, died.  From the pleadings, plaintiff’s allegations 
appear to be relatively straightforward and uncomplicated.  The NOI and AOMs alleged 
                                              
15 Id. (emphasis added). 
 
 
 
9
that professional negligence occurred during a visit to defendant Crittenton Hospital’s 
emergency room, where Ligons was seen by defendant David Bruce Bauer, M.D.  
Plaintiff claimed that Ligons had suffered a perforation of her colon during a recently 
performed colonoscopy and that she developed sepsis as a result of the perforation.  
Ligons went to the emergency room for follow-up treatment, and plaintiff claimed that 
Dr. Bauer failed to admit her to the hospital for the proper diagnostic testing and 
treatment.  Plaintiff further claimed that this improper treatment allowed the sepsis to 
become overwhelming, leading to multiple organ failure, causing Ligons’s death.  The 
NOI set forth the factual background of plaintiff’s claim:  
Edris Ligons was a 54-year-old woman, with a history of colon 
polyps, with one atypical polyp found on a previous colonoscopy.  She 
came to Crittenton Hospital for an out-patient follow-up colonoscopy on 
January 14, 2002.  Dr. Tayeb noted during the procedure that the colon was 
very tortuous and pressure had to be applied to reach the cecum.  The 
clinical diagnosis was diverticulosis and hemorrhoids. 
On January 22, 2002 Mrs. Ligons presented to the Emergency 
Department at Crittenton with a four-day history of vomiting, diarrhea, 
chills, and fever.  She had a fever of 102.4.  She had abdominal tenderness 
on examination.  She had a [white blood cell count] of 15,400.  An 
abdominal x-ray showed an abnormal gas pattern with mildly dilated small 
bowel loops, and paucity of gas or bowel content in the colon.  The report 
indicated that this could reflect early or partial bowel obstruction.  The 
radiologist specifically recommended progress views.  She was treated for 
gastroenteritis and dehydration.  She was given antibiotics and fluids.  She 
was discharged within six hours. 
She went to Dr. Tayeb’s office on the 23rd due to severe pain.  She 
was immediately sent to the Emergency Department.  Examination revealed 
changes consistent with peritonitis because of a perforated colon.  She 
developed sepsis.  Exploratory laparatomy revealed an extensive pelvic 
abscess, and surgical resection was not possible.  Despite extensive 
 
 
 
10
medication, the sepsis that developed due to the perforated colon led to 
multiple organ failure and death on January 29, 2002. 
Plaintiff’s supplemental NOI further stated: 
As a direct and proximate result of the negligence and malpractice 
alleged above Edris Ligons experienced conscious pain and suffering and 
ultimately died due to the negligence.  Specifically, had Dr. Bauer admitted 
the patient to the hospital on January 22, 2002 and had appropriate consults 
been obtained including surgery and [gastrointestinal] and had progress X-
rays been obtained the patients [sic] peritonitis would have been diagnosed 
much earlier.  The per[forated] colon would have been detected and surgery 
would have been performed much earlier.  This would have avoided the 
overwhelming sepsis that led to the multi organ system failure and 
ultimately death.   
The AOM signed by Dr. Fred Thomas certified that he had reviewed the NOI and 
all the medical records concerning the allegations contained in the notice and concluded, 
“It is my opinion that had the defendants admitted the patient to the hospital on 
January 22, 2002, and obtained the appropriate consults on January 22, 2002, as outlined 
in Dr. Sternbach’s affidavit that Edris Ligons would not have died.”  The AOM signed by 
Dr. George Sternbach similarly certified his review and concluded, “As a direct and 
proximate cause of the imprudent acts and omission committed by the individuals 
identified herein, Edris Ligons, died.” 
While I do not opine on whether plaintiff would ultimately prevail on the merits, it 
is pure folly to suggest that these statements do not meet the requirements of MCL 
600.2912d(1)(d).  To reach such an erroneous conclusion, the majority effectively ignores 
the statements that the “per[forated] colon would have been detected and surgery would 
have been performed much earlier” and “[t]his would have avoided the overwhelming 
sepsis that led to the multi organ system failure and ultimately death.”  The majority 
 
 
 
11
further ignores the Dr. Thomas’s certification that he had reviewed that statement and the 
supporting medical records and ignores his opinion that “had the defendants admitted the 
patient to the hospital on January 22, 2002, and obtained the appropriate consults on 
January 22, 2002, as outlined in Dr. Sternbach’s affidavit that Edris Ligons would not 
have died.” 
The majority’s conclusion that the contents of the NOI must be repeated in the 
AOM is at odds with the plain language of the statute.  Plaintiff’s AOMs met the 
requirements of MCL 600.2912d(1)(d).16  The AOMs, when read in concert with the 
NOI, set forth a “statement” regarding the “manner in which the breach of the standard of 
practice or care was the proximate cause of the injury alleged in the notice.”  Nothing 
more is required by the statute.  Thus, plaintiff’s AOMs were not defective.   
III.  DISMISSAL OF A CASE INVOLVING AN AOM WITH CONTENT DEFECTS IS 
NOT REQUIRED BY KIRKALDY 
 
The majority further errs by holding that if an AOM contains any defect, the only 
possible remedy is dismissal under Kirkaldy v Rim.17  In so opining, the majority expands 
the ruling of Kirkaldy well beyond its facts and legal conclusion.  In Kirkaldy, the 
plaintiff’s AOM was found to be defective because it was not signed by an expert who 
met the requirements of the expert-witness statute, MCL 600.2169.  The plaintiff in 
Kirkaldy was not seeking relief from a defect in content.  Instead, the plaintiff sought the 
                                              
16 This is not to suggest or imply that parties are not free to engage in repetition or that 
being repetitive renders an AOM defective.  Parties may be repetitive; however, it is not 
required by the statute.   
17 Kirklady, 478 Mich 581. 
 
 
 
12
ability to replace an AOM, signed by an unqualified expert, with an entirely new AOM 
signed by a qualified expert.  Thus, Kirkaldy addressed the ability to substitute the 
original AOM for one signed by an entirely different expert witness.  Nothing in Kirkaldy 
addressed an AOM containing purported defects in content.  Rather, the defect at issue in 
Kirkaldy was that the expert was not qualified to support the claim.  Significantly, the 
plaintiff in Kirkaldy filed a second complaint accompanied by a new AOM signed by a 
qualified expert. The plaintiff requested that the original case be dismissed without 
prejudice so that she could pursue the second complaint.  This Court simply granted one 
of the avenues of relief requested by the plaintiff when it dismissed the case without 
prejudice. 
 
Kirkaldy decided the issue of whether filing the original complaint tolled the 
period of limitations under MCL 600.5856, and this Court held that even an AOM signed 
by an unqualified expert tolls the period of limitations.  Kirkaldy did not address whether 
alternative remedies short of dismissal, such as amendment of an AOM, were available 
under MCL 600.2301.  Thus, it is erroneous to state that dismissal is the only remedy for 
an AOM with content defects because this Court did not address that issue in Kirkaldy. 
IV.  DISMISSAL OF AN AOM WITH CONTENT DEFECTS IS CONTRARY  
TO THE AOM STATUTE 
 
The proper starting point for identifying the required penalties and available 
remedies for AOMs with content defects is the language of the AOM statute itself.  While 
MCL 600.2912d(1) mandates that a plaintiff shall not commence an action for medical 
malpractice without timely filing an AOM, nothing in the plain language of this statute 
 
 
 
13
requires or compels dismissal of the case for defects in the AOM.  Despite the majority’s 
contrary conclusion, the AOM statute makes no reference whatsoever to a mandatory 
dismissal penalty in the event of a defect.  Instead, the statute is silent regarding the 
consequences of filing an AOM that contains content defects.  Thus, we must determine 
whether mandatory dismissal with prejudice was the intent of the Legislature when it 
enacted MCL 600.2912d.  
The legislative history of the AOM statute reveals that the Legislature did not 
intend for a defect in an AOM to be grounds for dismissal with prejudice.  The clearest 
indicator of this intent is the Legislature’s complete rejection of a “mandatory dismissal 
with prejudice” clause contained in the original draft of the legislation.  The AOM statute 
was originally introduced as part of Senate Bill No. 270 on January 28, 1993.  AOMs 
(referred to as “certificate[s]” in SB 270 as introduced) were addressed in proposed 
§ 2912d.  Proposed § 2912d contained a mandatory dismissal penalty.  The bill as 
introduced linked the NOI and the AOM together.  It also provided for dismissal of 
claims without the benefit of tolling afforded in MCL 600.5856, which in essence would 
have resulted in a dismissal with prejudice.  Section 2912d as introduced stated: 
(1) A person shall not commence an action alleging medical 
malpractice unless the complaint is accompanied by the certificate signed 
by the person or, if the person is represented by an attorney, by the attorney 
reflecting that the person has complied with section 2912f [concerning 
NOIs].  If the complaint is not accompanied by the certificate required 
under this subsection, the complaint does not toll the statute of limitations 
as provided in section 5856(1).  
 
 
 
 
14
(2) Except as otherwise provided in this subsection, in an action 
alleging medical malpractice, the court shall dismiss a claim not included 
in the notice required under section 2912f.  [Emphasis added; formatting 
altered from strikethrough/insert format to show language as proposed.] 
 
 
Significantly, while AOMs and NOIs remained linked in the version of the bill 
actually adopted, the penalty provisions did not survive.  There simply were not sufficient 
votes in the Legislature to enact a statute with such harsh penalties.  This unequivocally 
demonstrates that mandatory dismissal was not the will of the Legislature.  Michigan law 
makes clear that “[w]here the Legislature has considered certain language and rejected it 
in favor of other language, the resulting statutory language should not be held to 
explicitly authorize what the Legislature explicitly rejected.”18  Because the Legislature 
specifically omitted proposed dismissal language from the enrolled bill, it is unreasonable 
to conclude that the Legislature intended for courts to reinsert dismissal as the only 
permissible remedy.  The majority’s interpretation of the phrase “shall contain a 
statement” as meaning “shall dismiss the case if there is a possible defect no matter how 
minor” is misguided.19  
                                              
18 In re MCI Telecom Complaint, 460 Mich 396, 415; 596 NW2d 164 (1999); see also 
Univ Med Affiliates, PC v Wayne Co Executive, 142 Mich App 135, 140; 369 NW2d 277 
(1985) (holding that the legislative history of a statute may be considered, and if it can be 
shown that certain language was affirmatively rejected, the court should not give the 
statute a construction that the Legislature plainly refused to give it); Nation v WDE 
Electric Co, 454 Mich 489, 492-493, 495; 563 NW2d 233 (1997); Miller v State Farm 
Mut Auto Ins Co, 410 Mich 538, 566; 302 NW2d 537 (1981); and People v Adamowski, 
340 Mich 422, 429; 65 NW2d 753 (1954). 
19 It is ironic that the Legislature refused to enact the most severe penalty, dismissal with 
prejudice, for a complete failure to file an AOM, yet here, the majority adopts this severe 
penalty for purported minor content defects.  
 
 
 
15
V.  CONTENT DEFECTS IN AN AOM MAY BE CORRECTED 
 
The AOMs in this case were not defective.  However, even in cases involving 
AOMs with content defects, a party who files a defective AOM is entitled to seek relief.  
The first question is whether a plaintiff is entitled to relief under the former version of 
MCR 2.118.  The majority claims that a plaintiff whose case was pending while the 
former version of MCR 2.118 was in effect20 is not entitled to relief under the former rule 
because an AOM is not a pleading.  To reach this conclusion the majority disavows the 
holding in Barnett v Hidalgo, 478 Mich 151, 161; 732 NW2d 472 (2007), that an AOM is 
part of a pleading and, therefore, admissible as substantive evidence at trial because it 
constitutes an admission by a party opponent.  However, now the majority claims that 
because Barnett held that an AOM is only “part of the pleadings,”21 an AOM is not a 
“pleading” subject to amendment under MCR 2.118.  This distinction is dubious at best, 
as nothing in former MCR 2.118 stated or suggested that a pleading can be amended but 
a part of it cannot.   
                                              
20 On February 16, 2010, this Court amended the court rules to make it clear that AOMs 
may be amended.  Specifically, MCR 2.112(L)(2)(b) as amended now provides in 
pertinent part that “[a]n affidavit of merit or meritorious defense may be amended in 
accordance with the terms and conditions set forth in MCR 2.118 and MCL 600.2301.”  
The majority’s decision to preclude use of the amended rules conflicts with the general 
rule that “‘the norm is to apply the newly adopted court rules to pending actions unless 
there is reason to continue applying the old rules.’”  Reitmeyer v Schultz Equip & Parts 
Co, Inc, 237 Mich App 332, 337; 602 NW2d 596 (1999), quoting Davis v O’Brien, 152 
Mich App 495, 500; 393 NW2d 914 (1986); see also People v Jackson, 465 Mich 390; 
633 NW2d 825 (2001); 1 Longhofer, Michigan Court Rules Practice (5th ed), §§ 1102.1 
and 1102.2, pp 3-4. 
21 Barnett, 48 Mich at 161. 
 
 
 
16
Regardless of whether relief is available under the former court rule, the majority 
completely disregards MCL 600.2301.  Once again, this Court must turn to the actual 
language of the statute.  MCL 600.2301 contains two clear and unambiguous provisions:  
The court in which any action or proceeding is pending, has power 
to amend any process, pleading or proceeding in such action or proceeding, 
either in form or substance, for the furtherance of justice, on such terms as 
are just, at any time before judgment rendered therein.  The court at every 
stage of the action or proceeding shall disregard any error or defect in the 
proceedings which do not affect the substantial rights of the parties. 
The plain language of this statute imposes a duty that cannot be ignored on all 
courts of this state.  It requires that “[t]he court at every stage of the action or proceeding 
shall disregard any error or defect in the proceedings which do not affect the substantial 
rights of the parties.”  This is not a discretionary provision.  It is a legislative mandate 
that this Court must follow.  Unless substantial rights are affected, the court shall 
disregard any error or defect at every stage of the action or proceeding.  This provision 
applies to all actions or proceedings.  Thus, even if we were to accept the majority’s 
erroneous conclusion that an AOM is not a pleading, an AOM is nevertheless part of the 
“action” or “proceeding.”  Clearly, the failure to repeat statements already made cannot 
be characterized as affecting a substantial right.  According to the plain language of the 
statute, this Court must disregard technical defects, such as the ones the majority claims 
are in plaintiff’s AOMs.  By failing to do so, the majority ignores a clear and direct 
mandate imposed on this Court by the Legislature.  
Moreover, even in instances in which an AOM contains more substantial defects 
or substantial rights might be affected, trial courts still have discretion under MCL 
 
 
 
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600.2301 to afford relief by way of amendment when justice so requires.  MCL 600.2301 
states that “[t]he court in which any action or proceeding is pending, has power to amend 
any process, pleading or proceeding in such action or proceeding, either in form or 
substance, for the furtherance of justice, on such terms as are just . . . .”  MCL 600.2301 
clearly provides for amendment of more than just pleadings.  It allows for amendments of 
“any process, pleading or proceeding.”  An AOM is without question part of the process 
or proceeding.  Thus, an AOM is a document that courts have the power to amend.  
The majority claims it can disregard the plain language of MCL 600.2301 by 
asserting that Freer v White, 91 Mich 74, 76; 51 NW 807 (1892), represents the long-
established law in Michigan that amendment of an affidavit is prohibited.  However, the 
majority’s reliance on Freer (discussing “attachment” affidavits used in debtor-creditor 
disputes in the 1800s) is misguided.22  In Emerson v Detroit Steel & Spring Co, 100 Mich 
127, 132; 58 NW 659 (1894), this Court limited the holding in Freer to its facts and 
recognized that Freer had not overruled Barber v Smith, 41 Mich 138; 1 NW 992 (1879), 
which had previously allowed for amendments to attachment affidavits.23  Accordingly, 
                                              
22 Freer has not been cited as authority by any court in this state since 1907. 
23 Barber favored curing defects in an affidavit by amendment and held that “[t]his power 
to cure errors and irregularities by amendment is a useful one, if wisely exercised, and 
when no provision to the contrary is made it applies as fully to attachment suits as to 
others.”  Barber, 41 Mich at 144.  The defect at issue in Barber “was not such a defect as 
to necessarily and at once to destroy the process and put an end to the proceeding, but a 
defect remediable under the power of the court to correct errors in its proceedings during 
their progress.”  Id. at 145.  Accordingly, Barber concluded that “in case the proceeding 
while open, and at a stage permitting correction by amendment, should be brought into 
question collaterally, it would not be competent to reject it as void on account of the 
 
 
 
 
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Freer does not, as the majority claims, support its decision to ignore the plain language of 
MCL 600.2301.  
VI.  WHEN COURTS SHOULD ALLOW AMENDMENT OF AN AOM 
Next we must determine under what circumstances a court should allow 
amendment of an AOM with content defects that affect the substantial rights of the 
parties.  While allowing an amendment is a discretionary matter, a court should view a 
party’s request to amend in light of the statutory directive that amendments should be in 
“the furtherance of justice, on such terms as are just . . . .”24  If failing to allow 
amendment would result in the dismissal of a plaintiff’s case with prejudice, as the 
majority holds in this case, the result would not be in the furtherance of justice.  Such a 
result slams the courthouse doors in the plaintiff’s face, leaving that plaintiff without a 
forum in which to pursue a claim that an expert has certified as meritorious.   
Citizens of this state are entitled to a forum to resolve claims on their merits.  
Furtherance of justice cannot be achieved without providing citizens access to justice.  
Access to justice is a cornerstone of our system of jurisprudence, and without it, 
confidence in the judiciary is lost.  Allowing for amendment of an AOM to correct 
defects in content is in the furtherance of justice.  Such relief permits a plaintiff to pursue 
                                              
defect.”  Id.; see also Walden v Crego’s Estate, 288 Mich 564; 285 NW 457 (1939) 
(holding that statutorily required attachment affidavits that contain defects in content may 
be corrected by amendment). 
24 MCL 600.2301. 
 
 
 
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his or her claim and have it decided on its merits rather than on a hypertechnical reading 
of an AOM or a misguided reading of the AOM statute.   
Unfortunately, instead of following the rule of law, the majority denies the 
plaintiff in this case access to justice by rewriting the language of the AOM statute in 
order to come to its result.  
VII.  CONCLUSION 
I respectfully dissent from the majority’s decision to dismiss this medical 
malpractice action with prejudice.  The majority’s conclusions are erroneous because 
plaintiff’s AOMs were not defective and even in cases involving AOMs with content 
defects, MCL 691.2301 clearly provides relief.  Moreover, the plain language of the 
AOM statute does not contemplate, let alone require, that a plaintiff’s complaint be 
dismissed with prejudice for defects contained in an affidavit.  The majority’s decision 
ignores the plain language of the relevant statutes.  The majority abandons the rule of law 
and reaches its result by rewriting the applicable statutes.   
 
 
Diane M. Hathaway