Title: Winn v. Sunrise Hosp. & Med. Ctr.

State: nevada

Issuer: Nevada Supreme Court

Document:

428 Nev, Advance Opinion 23

IN THE SUPREME COURT OF THE STATE OF NEVADA

No, 54251

vo FILED
UNRISE HOSPITAL AND MEDICAL
ENTER; MICHAEL CICCOLO, M.D.; tat 31 2012

"LINICAL TECHNICIAN
SOCIATES, LLC; ROBERT TWELLS, wv
‘CP: AND LEE P, STEFFEN, CCP,

‘espondents,

|
|
sEDONA WINN, |
\ppellant, |

Appeal from a district court summary judgment in a medical
alpractice action. Eighth Judicial District Court, Clark County: Doug

chard Harris Law Firm and Kerry L. Earley, Las Vegas,
for Appellant.

Alverson Taylor Mortensen & Sanders and Shirley Blazich, David J.
lortensen, LeAnn Sanders, and Laura S. Lucero, Las Vegas.

1x Respondents Michael Ciccolo, M.D.i Chnical Technician Associates,
ILC: Robert Twells, CCP; and Lee P. Steffen, CCP.

 

Hall Prangle & Schoonveld, LLC, and Kenneth M. Webster and Jonquil L.
Urdaz, Las Vegas,
for Respondent Sunrise Hospital and Medical Center.

12-1704)

 
BEFORE THE COURT EN BANC.
OPINION

By the Court, PARRAGUIRRE, J.:

Nevada's statute of limitations governing medical malpractice
actions is NRS 41A.097. Subsection 2 of that statute provides that such
actions must be filed within three years of the injury date and within one
year of the injury's discovery. Both deadlines are tolled under subsection
3, however, when the health care provider has concealed information upon
which the action is based.

In this appeal, we consider three issues regarding NRS
41A.097 subsections 2 and 3. First, we consider the circumstances in
which a district court may appropriately determine, as a matter of law,
the accrual date for subsection 2's one-year discovery period. Second, we
consider the meaning of the term “concealed” in subsection 3 and examine
what a plaintiff must establish in order to warrant a tolling of subsection
2's limitation periods. Finally, we consider whether one defendant's
alleged concealment of records can be imputed to other defendants for
purposes of tolling subsection 2's limitation periods as to those defendants.

Because questions of fact remain as to whether subsection 2's
one-year discovery period was tolled for concealment against respondent
Sunrise Hospital and Medical Center, we vacate the district court's
summary judgment in this regard and remand for further proceedings.
However, because subsection 3's tolling-for-concealment provision does not
apply against respondents Michael Ciccolo, M.D.; Clinical Technician
Associates, LLC; Robert Twells, CCP; and Lee P. Steffen, CCP, we affirm

 

the district court's summary judgment in their favor.

 

 
8

 

FACTS AND PROCEDURAL HISTORY

On December 14, 2006, 13-year-old Sedona Winn underwent
heart surgery at respondent Sunrise Hospital and Medical Center.
Respondent Michael Ciccolo, M.D., was the operating physician who
performed the surgery, and respondents Robert Twells, CCP, and Lee
Steffen, CCP, were the perfusionists who acted as the pump team to
maintain Sedona’s blood flow during surgery (collectively, the doctors).

On the day after her surgery, Sedona’s father, Robert Winn,
was informed that she had suffered an “extensive brain injury” during the
surgery. The brain injury rendered Sedona comatose and has led to
permanent neurological impairment, In conveying this news to Winn, the
doctors were unable to provide an explanation for how this tragic result
arose from what was considered to be a relatively minor surgery.

By January 2007, Winn, acting as guardian ad litem for
Sedona, had retained an attorney to represent him in a medical
malpractice action against Sunrise and the doctors. In mid-January,
Winn's counsel sent a letter to Sunrise requesting that Sunrise produce
“all patient records” relating to Sedona’s surgery. Three days later,
Winn's attorney sent Sunrise a second records request, this time for
records pertinent to filing a claim for Social Security Disability benefits.

{Winn would also bring suit against Clinical Technician Associates,
LLC, the employer of two of the doctors, This opinion’s references to “the
doctors” include Clinical Technician Associates, LLC.

We also note that Sedona's mother, Tracy Winn, was substituted as
Sedona’s guardian ad litem during the pendency of this appeal. Because
Sedona's father served as her guardian in district court, we refer to Mr.
Winn in this opinion.

 
On February 14, 2007, in connection with the Social Security-
related request, Sunrise provided Winn’s attorney with a copy of 182 pages
of records, which included Dr. Ciccolo’s December 14, 2006, postoperative
report. According to an affidavit Winn’s medical expert would later
produce, Dr. Ciccolo's report indicated that a “notable volume of air” was
present in Sedona’s left ventricle at “inappropriate times during the
[surgical] procedure.”

‘These 182 pages of records were sufficient for Winn’s attorney
to successfully pursue Sedona’s Social Security claim. However, due to
several delays, the reasons for which are still in dispute, Sunrise did not
provide Winn's attorney with any additional records until December 2007.
Even at this point, the records provided were only a “nearly complete” set.
Not until February 12, 2008, did Sunrise finally provide Winn's attorney
with a complete set of Sedona's records, which included a post-surgery
MRI and CT sean.

Having obtained Sedona’s complete set of records, Winn's
attorney procured an expert affidavit in which a medical expert opined
that Sunrise and the doctors had negligently caused Sedona’s injuries In

formulating his opinions, Winn's expert rolied primarily on Dr. Ciccolo's

*Subject to exceptions not applicable here, NRS 41A.071 requires a
district court to dismiss a medical malpractice complaint unless an expert
affidavit is filed with the complaint. The affidavit must “support{] the
allegations” contained in the complaint and must be “submitted by a
medical expert who practices or has practiced in an area that is
substantially similar to the type of practice engaged in at the time of the
alleged malpractice.” NRS 41A.071.

The record on appeal indicates that Winn procured two expert
affidavits. For the sake of clarity, this opinion refers to these affidavits in
the singular,

 

 

 

 
sstoperative report that Winn received from Sunrise on February 14,
2007. After obtaining the expert affidavit, Winn filed suit against Sunrise
ind the doctors on February 8, 2009.

Each of the respondents moved to dismiss Winn’s complaint on

the basis that it was barred by NRS 41A.097(2). Each respondent

yntended that because more than one year had elapsed between the time

yhen Winn “discovered” Sedona's injury and the time when he filed suit,

is claims were time-barred. Concluding that Winn had discovered

sdona’s injury on December 15, 2006—the day following her surgery—
he district court granted respondents’ motions. ‘This appeal followed.

DISCUSSION

Before considering Winn's arguments on appeal, we first
xplain NRS 41A.097’s general framework. In relevant part, NRS
1.097 provides:

2. Except as otherwise provided in subsection 3, an
action for injury or death against a provider of health care
may not be commenced more than 3 years after the date of
injury or 1 year after the plaintiff discovers or through the use
of seasonable- diligence should have discovered the injury,
which

3. This time limitation is tolled for any period during
which the provider of health care has concealed any act, error
or omission upon which the action is based and which is
known or through the use of reasonable diligence should have
been known to the provider of health care.

(Emphases added.)
All parties to this appeal agree that Sedona’s injury occurred
10 later than December 15, 2006, the day after her surgery when she was

sndered comatose. The parties also correctly agree that subsection 2, by

 

 
0 Be

 

its terms, requires Winn to satisfy both the one-year discovery period and
the three-year injury period.

‘The parties disagree, however, regarding three issues.’ First,
the parties disagree as to when Winn “discovered” Sedona’s injury for
purposes of triggering subsection 2's one-year discovery period. Second,
Winn and Sunrise dispute the meaning of subsection 3's use of the term
“concealed” as it relates to Sunrise’s piecemeal production of records and
Winn's resulting delay in filing suit, Finally, Winn and the doctors
disagree as to whether Sunrise’s alleged concealment of records can serve
as a basis for tolling the one-year discovery period on Winn’s claims
against the doctors, who played no role in the alleged concealment.

As explained below, the accrual date for subsection 2's one-
year discovery period ordinarily presents a question of fact to be decided
by the jury. Only when evidence irrefutably demonstrates this accrual
date may a district court make such a determination as a matter of law.
Although the evidence in this case docs irrefutably demonstrate the
accrual date, this date was two months Iater than the date identified by
the district court. We conclude that this difference in timing, combined
with our analysis below, may render Winn's claim against Sunrise timely

if tolling principles apply.

®Winn also argues that NRS 41A.097's lack of a minority tolling
provision renders the statute unconstitutional. Because he did not raise
this argument in district court, we decline to address it on appeal. See

Munoz v, State ex rel, Dep't of Hwvs., 92 Nev. 441, 444, 552 P.2d 42, 43-44
(1976) (refusing to consider a constitutional challenge that was not first
raised in district court),

 
   
   
   
   
    
   
   
    
   
   
  
  
    
   
 

We next conclude that a plaintiff must satisfy a two-prong test
order to establish that subsection 2's limitation periods should be tolled
for concealment. Because factual issues remain as to whether Sunrise (1)
tentionally withheld information that (2) was “material,” meaning the
formation would have hindered a reasonably diligent plaintiff from
imely filing suit, we vacate the district court's summary judgment in
favor of Sunrise and remand go that Winn can be afforded the opportunity
make these showings.

We further conclude, however, that one defendant's
ncealment cannot serve as a basis for tolling subsection 2's limitation

jeriods as to defendants who played no role in the concealment. Thi

 

mnelusion, combined with the date when the one-year discovery period
irrofutably accrued, renders Winn’s claims against the doctors time:
sarred, We therefore affirm the district court's summary judgment in
wor of the doctors.
indard of review

Because the district court considered evidence outside of the

Jleadings in granting respondents’ motions to dismiss, we treat each

 

ismissal order as an order granting summary judgment. Witherow
tate, Bd. of Parole Comm'rs, 123 Nev. 305, 308, 167 P.3d 408, 409 (2007).

We review an appeal from an order granting summary
judgment de novo. Wood v, Safeway, Inc., 121 Nev. 724, 729, 121 P.3d
1026, 1029 (2005). Summary judgment is appropriate “when the
Jleadings and other evidence on file demonstrate that no ‘genuine issue as

   

any material fact [remains] and that the moving party is entitled to a
judgment as a matter of law.” Id. (alteration in original) (quoting NRCP
(2). When deciding a motion for summary judgment, “the evidence, and

  

 
any reasonable inferences drawn from it, must be viewed in a light most
favorable to the nonmoving party.” Id.

NRS 41A.097(2)’s discovery date may be determined as a matter of law
only when the evidence irrefutably demonstrates that a plaintiff has been
put on inquiry notice

Winn filed suit against all respondents on February 3, 2009.
‘Thus, absent any tolling of subsection 2's one-year discovery period, Winn
would have had to discover Sedona’s injury no earlier than February 3,
2008.

In Massey v, Litton, 99 Nev. 723, 669 P.2d 248 (1983), this
court held that a plaintiff “discovers” his injury “when he knows or,
through the use of reasonable diligence, should have known of facts that
would put a reasonable person on inquiry notice of his cause of action.” 99
Nev. at 728, 669 P.2d at 262 (emphasis added). While difficult to define in
concrete terms, a person is put on “inquiry notice” when he or she should
have known of facts that “would lead an ordinarily prudent person to
investigate the matter further.” Black's Law Dictionary 1165 (9th ed.
2009). We reiterated in Massey that these facts need not pertain to
precise legal theories the plaintiff may ultimately pursue, but merely to
the plaintiff's general belief that someone's negligence may have caused
his or her injury. 99 Nev. at 728, 669 P.2d at 252. ‘Thus, Winn
“discovered” Sedona’s injury at a point when he had facts before him that
would have led an ordinarily prudent person to investigate further into
whether Sedona’s injury may have been caused by someone's negligence,

In granting respondents’ summary judgment motions, the

 

district court concluded as a matter of law that Winn discovered Sedona’
injury on December 15, 2006, the day following her surgery, when

respondents were unable to provide an explanation for the surgery's

 

 
oo no

 

catastrophic result. We believe this was improper, as “(t]he appropriate
accrual date for the statute of limitations is a question of law only if the
facts are uncontroverted.” Dav v. Zubel, 112 Nev. 972, 977, 922 P.24 536,
589 (1996); see also Bemis v. Estate of Bemis, 114 Nev. 1021, 1025, 967
P.2d 437, 440 (1998) ("Dismissal on statute of limitations grounds is only

 

appropriate ‘when uncontroverted evidence irrefutably demonstrates
plaintiff discovered or should have discovered’ the facts giving rise to the
cause of action.” (quoting Nevada Power Co. v, Monsanto Co,, 955 F.2d
1304, 1307 (9th Cir. 1992)).

Here, the record is unclear

 

to what respondents specifically
conveyed to Winn in the wake of Sedona’s surgery, and respondents’
failure to provide Winn with an explanation is not, in and of itself, a tacit
acknowledgment of negligence. Similarly, it is unlikely that an ordinarily

prudent person would begin investigating whether a cause of action might

 

exist on the same day as being informed that his or her child's surgery had
gone drastically wrong. Accordingly, the evidence does not “irrefutably
domonstrato[ J" that Winn discovered Sedona’s injury on December 15,
2006. Bemis, 114 Nev. at 1025, 967 P.2d at 440 (internal quotation marks
omitted). The district court therefore erred in determining as a matter of
law that subsection 2's one-year discovery poriod accrued on December 15,
2006.

However, the evidence does irrefutably demonstrate that
Winn discovered Sedona’s injury no later than February 14, 2007—the
date when he received the initial 182 pages of medical records. At this
point, Winn had not only hired an attorney to pursue a medical
malpractice action, but he also had access to Dr. Ciccolo's postoperative
report that referenced air being present in Sedona’s heart at inappropriate

 
times during the surgery. By this point at the latest, Winn and his
attorney had access to facts that would have led an ordinarily prudent
person to investigate further into whether Sedona’s injury may have been
caused by someone's negligence. Massey, 99 Nev. at 728, 669 P.2d at 252
Thus, as a matter of law, the evidence irrefutably demonstrates that Winn

February 14, 2007. Bemis, 114 Nev. at 1025, 967 P.2d at 440.

 

put on inguiry notice of his potential cause of action no later than

in_as to whether subsection 2's one- cover
period should have been tolled due to Sunrise's alleged concealment of

records

Winn argues alternatively that his February 3, 2009, lawsuit
is timely as to all respondents because subsection 2's one-year discovery
period should have been tolled for concealment pursuant to subsection 3
until February 12, 2008. This is the date when Sunrise ultimately
provided Winn with a complete set of records, which, according to Winn,

was necessary to procure an expert affidavit.+

‘We recognize that some jurisdictions with similar statutes of
limitation refuse to toll their respective discovery periods. Sco, o..,
Sanchez _v. South Hoover Hospital, 553 P.2d 1129, 1134 (Cal. 1976)
(Notwithstanding a defendant's continuing efforts to conceal, if plaintiff
discovers the claim independently, the limitations period commences.”);
Shockley v. Dver, 456 A.24 798, 799 (Del. 1983) (‘Where there has been
fraudulent concealment from a plaintiff, the statute is suspended only
until his rights are discovered or until they could have been discovered by
the exercise of reasonable diligence.”)

We decline to follow this approach, as subsection 3's plain language
makes clear that the tolling-for-concealment exception applies to
subsection 2 as a whole—not just to the outer three-year injury period.
See Karcher Firestopping v, Meadow Valley Contr., 125 Nev. 111, 113, 204
P.3d 1262, 1263 (2009) (“If a statute's language is clear and unambiguous,
this court will apply its plain language.”). Considering NRS 41A.071's

continued on next page .

 

 

 
oe  Thus, regardless of a

   

plaintiff's subjective concern regarding the significance of withheld
information, the plaintiff must show that this information would have
objectively hindered a reasonably diligent plaintiff from timely filing suit.
In other words, the plaintiff must show that the withheld information was
“material.” Cf, Basic Inc, v. Levinson, 485 U.S, 224, 240 (1988) (equating
“materiality” of undisclosed information with the significance that a
“reasonable investor” would ascribe to the information); Restatement
(Gecond) of Torts § 538(2)(a) (1977) (indicating that a matter is “material”
if ‘a reasonable man would attach importance to its existence or

nonexistence in determining his choice of action’.

SGiven subsection 3's applicability to both of subsection 2's
limitation periods, this interpretation is proper. Karcher, 125 Nev. at 113,
204 P.3d at 1263 (The goal of statutory interpretation is to effectuate the
Legislature's intent.”

 

 
Accordingly, when subsection 3 and subsection 2 are read in
ndem, Winn must satisfy the following two-prong test in order to
sstablish that subsection 2's one-year discovery period should be tolled: (1)
hat Sunrise intentionally withheld information, and (2) that this
ithholding would have hindered a reasonably diligent plaintiff from
rocuring an expert affidavit.

As to whether Sunrise intentionally withheld information, the
cord on appeal provides us with no clear guidance. Winn evidently
anceled and reinstated the same records request on numerous occasions,
yhich may have left Sunrise without clear direction as to whether it
thould provide the roughly 3,000 additional pages of records in addition to
¢ 182 pages it had already provided Winn in February 2007. Although

he district court's summary judgment order did conclude that subsection

 

"'s tolling provision was inapplicable, it provided no factual findings to
support this conclusion—for example, when Winn had a pending request
ind what Sunrise’s response was to this request. Thus, factual issues
main as to when Sunrise was presented with an unequivocal request for
edical records and whether Sunrise, upon receiving this request,
intentionally withheld the requested records.
‘As to whether such withholding would have hindered a
asonably diligent plaintiff from procuring an expert affidavit, Sunrise
nd Winn are in disagreement. Sunrise indicates that even once Winn,
rocured his expert affidavit, the expert relied largely upon Dr. Ciccolo’s
sstoperative report, a document that was among the initial 182 pages of

cords that Sunrise provided in February 2007. Thus, Sunrise contends,

 

 
vven if the delay in providing a complete set of records may have hindered
‘nn from filing suit, the delay would not have hindered a reasonably
igent plaintiff from doing the same.

Winn, on the other hand, indicates that these initial 182 pages
id not contain records such as Sedona’s post-surgery MRI and CT scans—
cords that Winn contends were critical for his expert's review of the
se. In other words, Winn contends that even though his expert may not
ave expressly referenced these particular records in his affidavit, it was
jonetheless imperative that his expert review them before opining under

th that respondents were negligent,

At its core, the parties’ disagreement comes down to a
juostion of materiality. Although Winn's expert may ultimately have

ferenced the postoperative report in his affidavit, the record on appeal is
ilont as to whether other records were material to conducting a full
wiew, of Sedona’s case. Soe Levinson, 485 U.S. at 240; Restatement
(Second) of Torts § 538(2\(a) (197). ‘Thus, based upon the facts before us,
/e are unable to affirm the district court’s summary judgment in favor of
junrise, and we therefore vacate that order.

On remand, Winn is to be afforded an opportunity to show
hat subsection 2's one-year discovery period should have been tolled as to
is claim against Sunrise. Winn must satisfy a tworprong test: (1) that
‘unrise intentionally withheld records after being presented with an

yequivocal request for them, and (2) that this intentional withholding
ould have hindered @ reasonably diligent plaintiff from procuring an

sxpert affidavit.

 

 
 

‘One defendant's concealment cannot toll the statute of limitations as to a
second defendant who played no role in the concealment

Again relying on subsection 3's_ tolling-for-concealment
language, Winn contends that Sunrise’s alleged concealment serves to toll
subsection 2's one-year discovery period as to all respondents in this
case—Sunrise and the doctors alike. The doctors disagree. They contend
that Winn's only allegation of concealment was directed toward Sunrise,
the party who had access to the records in question and the only party
from whom Winn requested any records. Thus, the doctors conclude,
because Winn has not alleged that the doctors concealed anything from
him that could plausibly warrant tolling the one-year discovery period as
to them, his claims against them are time-barred.

We agree with the doctors. Subsection 3's plain language
states that subsection 2s limitation periods are tolled “for any period
during which the provider of health care has concealed any act, error or
omission upon which the action is based.” NRS 41A.097(3) (emphasis
added). By using this defendant-specific language, it is apparent that the
Legislature meant for subsection 3 to toll subsection 2's limitation periods
only with respect to the defendant responsible for the concealment. See
Sheriff v. Burcham, 124 Nev. 1247, 1258, 198 P.8d 326, 329 (2008) (W]e

 

only look beyond the plain language of the statute if that language is
ambiguous or its plain meaning clearly was not intended.’).

This conclusion is reinforced by the _publie-policy
considerations that form the basis for any statute of limitations, Namely,
such limitation periods are meant to provide a concrete time frame within
which a plaintiff must file a lawsuit and after which a defendant is
afforded a level of security. See Petersen v. Bruen, 106 Nev. 271, 274, 792
P.2d 18, 19 (1990) ({S}tatutes of limitation embody important public

15

 
wlicy considerations in that they stimulate activity, punish negligence,
\d promote repose by giving security and stability to human affairs.”

(internal quotation marks omitted))
In this regard, a tolling-for-concealment provision included

within a generally applicable statute of limitations is an exception to the

 

Jceneral rule, meant merely to prevent a defendant from taking affirmative
Jaction to prevent the plaintiff from bringing suit, Brown v, Bleiberg, 651
IP.2d 815, 821 (Cal. 1982) ("(T]he rationale of the tolling doctrine is
Jestoppel.”); Smith v, Bovett, 908 P.2d 508, 512 (Colo. 1995) (“The knowing
Jconcealment exception...embodies the common law concept that a
|rongdoer should not be able to take advantage of his own wrong.”).

‘Thus, within this public-policy framework, a defendant who
fhas done nothing to delay a plaintiff's lawsuit should not be punished
jsolely on the basis of an unrelated third party’s conduct. See Jensen_v,
IIE Hospitals, Inc,, 82 P.34 1076, 1083 (Utah 2003) (“[TIhe alleged fraud
lof one defendant generally cannot be imputed to another defendant for

 

tolling purposes when the other defendant did not participate in the
jalleged fraud,” (footnote omitted); see also Brown, 651 P.2d at 821
(declining to toll a medical malpractice statute of limitations as to one
Jdefendant when the only alleged concealment was by a different
defendant).

In this case, Winn's only allegation of concealment was
Jdivected toward Sunrise, as he never requested any records from the
Jdoctors. He therefore cannot rely on subsection 3 as a basis for tolling

Jsubsection 2's one-year discovery period as to the doctors. Because he

ldiscovered Sedona’s injury no later than February 14, 2007, and because
Ihe filed suit against the doctors on February 3, 2009. Winn's claims

 

 
 

gainst the doctors are time-barred by subsection 2's one-year discovery
weriod. We therefore affirm the district court’s summary judgment in
favor of respondents Michael Ciccolo, M.D.; Clinical Technician Associates,
LLC; Robert Twells, CCP; and Lee P. Steffen, CCP.
CONCLUSION
We conclude that the accrual date for NRS 41A.097(2)'s one:

 

ear discovery period ordinarily presents a question of fact to be decided
y the jury. Only when the evidence irrefutably demonstrates that a
laintiff was put on inquiry notice of a cause of action should the district,
urt determine this discovery date as a matter of law. Although we agree
ith the district court that the evidence in this case irrefutably
jemonstrates that Winn was put on inquiry notice, we disagree as to when
this occurred. This difference in timing, combined with our analysis of
'S 41A.097(3)'s tolling-for-concealment provision, precludes affirming
district court's summary judgment in favor of Sunrise.

With regard to Winn's tolling-for-concealment argument, we
elude that factual issues remain as to whether Sunrise concealed
cords from Winn so as to warrant tolling NRS 41A.097(2)'s one-year
iscovery period. We therefore vacate the district court's summary

jidgment in favor of Sunrise and remand this case so that Winn may be

forded an opportunity to show that Sunrise intentionally withheld

ds that would have hindered a reasonably diligent plaintiff from
rocuring an expert affidavit.

We further conclude, however, that one defendant's
mcealment cannot serve as a basis for tolling NRS 414.097(2)s statutory

tation periods as to defendants who played no role in the concealment.
Mhis conclusion, combined with the date when Winn was irrefutably put

inquiry notice, renders Winn’s claims against the doctors time-barred.

WwW

 
   
  

   

We therefore affirm the district court's summary judgment in favor of the
doctors.

jarraguirre

od.

 

Gibbons

Pickering

[hen tech, J.

Hardesty