Title: Joseph J. Paul v. Frederick C. Skemp, Jr.

State: wisconsin

Issuer: Wisconsin Supreme Court

Document:

2001 WI 42 
 
SUPREME COURT OF WISCONSIN 
 
 
Case No.: 
99-1810 
 
 
Complete Title 
of Case: 
 
Joseph J. Paul, Judith E. Paul, and The Estate 
of Jennifer Jo Paul,  
 
Plaintiffs-Appellants-Petitioners, 
 
v. 
Frederick C. Skemp, Jr., M.D., ABC Insurance 
Company, Virginia A. Updegraff, M.D., DEF 
Insurance Company, Skemp Clinic, Ltd., and GEH 
Insurance Company,  
 
Defendants-Respondents, 
Wisconsin Patients Compensation Fund,  
 
Defendant.  
 
 
REVIEW OF A DECISION OF THE COURT OF APPEALS 
Reported at:  238 Wis. 2d 94, 617 N.W.2d 677 
 
 
(Ct. App. 2000-Unpublished) 
 
 
Opinion Filed: 
May 3, 2001 
Submitted on Briefs: 
      
Oral Argument: 
February 28, 2001 
 
 
Source of APPEAL 
 
COURT: 
Circuit 
 
COUNTY: 
La Crosse 
 
JUDGE: 
John A. Damon 
 
 
JUSTICES: 
 
Concurred: 
      
 
Dissented: 
      
 
Not Participating:       
 
 
ATTORNEYS: 
For the plaintiffs-appellants-petitioners there 
were briefs by James R. Koby and Parke O’Flaherty, Ltd., La 
Crosse, and oral argument by James R. Koby. 
 
 
For the defendants-respondents there was a brief 
 
2 
by Virginia L. Newcomb, Patrick S. Nolan and Borgelt, Powell, 
Peterson & Frauen, S.C., Madison, and oral argument by Virginia 
L. Newcomb. 
 
 
An amicus curiae brief was filed by Edward E. 
Robinson and Cannon & Dunphy, S.C., Brookfield, on behalf of the 
Wisconsin Academy of Trial Lawyers. 
 
2001 WI 42 
 
NOTICE 
This opinion is subject to further editing and 
modification.  The final version will appear 
in the bound volume of the official reports. 
 
 
No. 99-1810 
 
STATE OF WISCONSIN                    :  
  IN SUPREME COURT 
 
 
Joseph J. Paul, Judith E. Paul, and The  
Estate of Jennifer Jo Paul,  
 
          Plaintiffs-Appellants- 
          Petitioners, 
 
     v. 
 
Frederick C. Skemp, Jr., M.D., ABC  
Insurance Company, Virginia A. Updegraff,  
M.D., DEF Insurance Company, Skemp  
Clinic, Ltd., and GEH Insurance Company,  
 
          Defendants-Respondents, 
 
Wisconsin Patients Compensation Fund,  
          Defendant. 
 
 
REVIEW of a decision of the Court of Appeals.  Reversed and 
cause remanded. 
 
¶1 
N. PATRICK CROOKS, J.   The issue in this case is 
whether the statute of limitations for medical malpractice 
claims in Wis. Stat. § 893.55 (1995-96)1 bars this action.  
Joseph J. and Judith E. Paul, and the Estate of Jennifer Jo Paul 
                     
1 All subsequent references to the Wisconsin Statutes are to 
be the 1995-96 version unless otherwise indicated.  
FILED 
 
MAY 3, 2001 
 
Cornelia G. Clark 
Clerk of Supreme Court 
Madison, WI 
 
 
 
 
 
No. 
99-1810 
 
 
2 
(collectively the "Pauls") brought this action in La Crosse 
County Circuit Court against Dr. Frederick Skemp, Dr. Virginia 
Updegraff and the Skemp Clinic (collectively "Skemp").  The 
Pauls claim that Skemp misdiagnosed the cause of recurring 
headaches Jennifer suffered, and that the misdiagnosis resulted 
in the rupture of a malformed blood vessel in Jennifer's brain 
which subsequently caused her death.  The circuit court, Judge 
John 
A. 
Damon 
presiding, 
concluded 
that 
the 
statute 
of 
limitations started running at the time of the last alleged 
misdiagnosis, when Jennifer last complained to Skemp about 
headaches; and that the Pauls' action was filed after that 
limitation period had run. The court of appeals agreed, and 
affirmed the circuit court.  Paul v. Skemp, No. 99-1810, 
unpublished slip op. (Wis. Ct. App. June 8, 2000). 
¶2 
The Pauls contend here, as they have before the 
circuit court and court of appeals, that what triggered the 
statute of limitations was not the alleged misdiagnosis, but the 
injury that resulted from that misdiagnosis, the rupture of the 
blood vessel.  We agree with the Pauls.  A misdiagnosis may be a 
negligent omission, but it is not, in and of itself, an injury. 
 The Pauls' claim for medical malpractice did not, and could 
not, accrue until Jennifer suffered an injury.  Accordingly, 
because this action was filed within the limitations period 
triggered by Jennifer's injury, it is timely, and summary 
judgment in favor of defendants was improper.  We thus reverse 
the decision of the court of appeals and remand the case to the 
circuit court for further proceedings.   
No. 
99-1810 
 
 
3 
I 
¶3 
Jennifer Paul was 19 years old when she died.  She 
first complained to the Skemp Clinic about headaches when she 
was 9 years old, in 1984.  Over the next ten years, Jennifer 
complained about headaches at least one dozen times.  She 
sometimes complained that vomiting or nausea accompanied the 
headaches, and sometimes complained about dizzy spells.   
¶4 
On November 20, 1994, Jennifer saw Dr. Skemp and 
indicated that she had suffered from headaches for some time.  
Dr. Skemp concluded, as others at Skemp had over the past 10 
years, that Jennifer's headaches were probably sinus related.  A 
month later, on December 20, 1994, Jennifer saw Dr. Updegraff 
and complained of "persistent headaches and dizzy spells over 
the past year," as well as frequent nausea.  (R. at 8:63.)  Dr. 
Updegraff also concluded that Jennifer may have been suffering 
from a sinus problem.   
¶5 
Jennifer's last visit to the Skemp Clinic was on March 
17, 1995.  She saw Dr. Theodor Habel, and according to the 
medical records, complained only of a sore throat.  The morning 
of May 22, 1995, Jennifer was taken to an emergency room.  
There, it was found that an arteriovenous malformation ("AVM") 
in Jennifer's right cerebellum had ruptured, causing extensive 
hemorrhaging.  Jennifer died on May 23, 1995. 
¶6 
On March 16, 1998, the Pauls filed a complaint against 
 the Skemp defendants.2  The complaint alleges that the 
                     
2  Employers Insurance of Wausau was originally a Plaintiff-
Subrogee, but was later dismissed.  
No. 
99-1810 
 
 
4 
defendants failed to diagnose the AVM and misdiagnosed the cause 
of Jennifer's headaches.  In the complaint, Joseph J. and Judith 
E. Paul, Jennifer's parents, seek damages for the loss of 
society and companionship.  The Pauls also seek survivor 
damages; and the Estate of Jennifer Jo Paul seeks damages for 
the fear, pain and suffering allegedly suffered by Jennifer 
prior to her death. 
¶7 
Skemp moved for summary judgment, contending that the 
lawsuit was not timely filed.  The circuit court agreed, granted 
summary judgment, and dismissed the action.  The Pauls appealed. 
 The court of appeals affirmed, and this court granted the 
Pauls' petition for review. 
II 
¶8 
This court reviews summary judgment decisions by 
employing the same methodology used by the circuit court in 
deciding motions for summary judgment.  First, the court reviews 
the pleadings to determine whether a claim has been stated, and 
if so, whether there are disputed issues.  Tamminen v. Aetna 
Cas. & Sur. Co., 109 Wis. 2d 536, 550, 327 N.W.2d 55 (1982).   
There is no dispute that the Pauls have stated a claim for 
negligence and that there are disputed issues regarding that 
claim.   
¶9 
Notwithstanding a dispute on the merits, a defendant 
may be entitled to summary judgment by establishing that the 
action was not filed within the limitations period set forth in 
the statute of limitations.  
 
No. 
99-1810 
 
 
5 
If the complaint states a claim and the pleadings show 
the existence of factual issues, the court examines 
the moving party's (in this case the defendants') 
affidavits or other proof to determine whether the 
moving party has made a prima facie case for summary 
judgment under sec. 802.08(2). To make a prima facie 
case for summary judgment, a moving defendant must 
show a defense which would defeat the plaintiff.  If 
the moving party has made a prima facie case for 
summary 
judgment, 
the 
court 
must 
examine 
the 
affidavits and other proof of the opposing party 
(plaintiffs in this case) to determine whether there 
exist disputed material facts, or undisputed material 
facts from which reasonable alternative inferences may 
be drawn, sufficient to entitle the opposing party to 
a trial.   
Id. (quoting Grams v. Boss, 97 Wis. 2d 332, 338, 294 N.W.2d 473 
(1980)).    
¶10 Whether, as Skemp contends, the action is time-barred 
by the statute of limitations that governs medical malpractice 
actions, Wis. Stat. § 893.55, involves statutory construction.  
Such statutory construction is a question of law, which we 
review de novo, even though we benefit from the analyses of the 
circuit court and the court of appeals.  Czapinski v. St. 
Francis Hosp., 2000 WI 80, ¶12, 236 Wis. 2d 316, 613 N.W.2d 120; 
see also Patients Compensation Fund v. Lutheran Hosp., 223 
Wis. 2d 439, 454-55, 588 N.W.2d 35 (1999).  "A court will not 
ordinarily engage in statutory construction unless a statute is 
ambiguous. 
 
'When 
a 
statute 
is 
plain 
and 
unambiguous, 
interpretation is unnecessary and intentions cannot be imputed 
to the legislature except those to be gathered from the terms of 
the statute itself.'" Czapinski, 2000 WI 80 at ¶17 (citing and 
No. 
99-1810 
 
 
6 
quoting Harris v. Kelley, 70 Wis. 2d 242, 249, 234 N.W.2d 628 
(1975)). 
III 
¶11 As just noted, the statute at issue is Wis. Stat. 
§ 893.55(1).  Section 893.55(1) provides that:  
 
[A]n action to recover damages for injury arising from 
any treatment or operation performed by, or from any 
omission by, a person who is a health care provider, 
regardless of the theory on which the action is based, 
shall be commenced within the later of: 
 
(a) Three years from the date of the injury, or 
 
(b) One year from the date the injury was 
discovered or, in the exercise of reasonable 
diligence should have been discovered, except 
that an action may not be commenced under this 
paragraph more than 5 years from the date of the 
act or omission. 
¶12 Skemp contends that Wis. Stat. § 893.55(1) bars the 
Pauls' action because the action was filed more than three years 
after Jennifer's injury.  According to Skemp, Jennifer's injury 
is the alleged misdiagnosis, which last occurred when Jennifer 
last complained about her headaches to Dr. Virginia Updegraff on 
December 20, 1994.  This action was not filed until March 16, 
1998.  Skemp also contends that the Pauls' action is untimely 
because the Pauls discovered Jennifer's injury, at the very 
latest, on the day she died, May 23, 1995; correspondingly, the 
Pauls' action should have been filed one year after the Pauls 
discovered Jennifer's injury, by May 23, 1996. 
¶13 In contrast, the Pauls contend that the injury that 
triggered the statute of limitations in Wis. Stat. § 893.55(1) 
No. 
99-1810 
 
 
7 
is the rupture of the AVM in Jennifer's brain and the resultant 
hemorrhaging.  That injury occurred on May 22, 1995, and, 
according to the Pauls, the action was timely filed, less than 
three years later, on March 16, 1998.  The Pauls additionally 
submitted, in opposition to Skemp's motion for summary judgment, 
an affidavit from an expert witness, who concluded, to a 
reasonable degree of medical certainty, that had Jennifer's AVM 
"been properly diagnosed at any time prior to May 1, 1995, it is 
more likely than not that [Jennifer] would not have sustained 
the injury and disability she ultimately experienced on May 22, 
1995."  (R. at 11:5.) 
¶14 The Pauls also contend that, alternatively, Jennifer 
complained about her headaches to Dr. Habel when she last 
visited Skemp on March 17, 1995.  Even though the medical 
records do not reflect that complaint, the Pauls point to Judith 
Paul's deposition testimony that Jennifer had told her that she 
had complained about her headaches to Dr. Habel.  The Pauls also 
point to an affidavit from Jennifer's boyfriend, Kevin Mason, 
that Jennifer told him before the appointment that she intended 
to complain about her headaches, and that Jennifer told him 
after the appointment that she had complained to Dr. Habel.  
Correspondingly, according to the Pauls, the last negligent act 
by defendants was March 17, 1995, and this action was timely 
filed within three years, on March 16, 1998. 
¶15 The running of the statute of limitations turns on 
when the claims accrue, as compared to when the action is filed. 
 "[A] period of limitation within which an action may be 
No. 
99-1810 
 
 
8 
commenced is computed from the time that the cause of action 
accrues until the action is commenced."  Wis. Stat. § 893.04.   
"An action is commenced, within the meaning of any provision of 
law which limits the time for the commencement of an action, as 
to each defendant, when the summons naming the defendant and the 
complaint are filed with the court . . . ."  Wis. Stat. 
§ 893.02. 
¶16 Although "[t]his court has the power to establish when 
claims accrue," the legislature has established when medical 
malpractice claims accrue in Wis. Stat. § 893.55(1).  Hansen v. 
A.H. Robins, 113 Wis. 2d 550, 559, 335 N.W.2d 578 (1983). 
 The 
plain language of § 893.55(1) indicates that medical malpractice 
claims accrue at the time of an injury or the discovery of an 
injury.3  That is, there is an injury rule of accrual in 
§ 893.55(1)(a), 
and 
a 
discovery 
rule 
of 
accrual 
in 
§ 893.55(1)(b).  The running of the limitations period is 
correspondingly triggered by the injury or the discovery 
thereof. 
¶17 That an injury or the discovery of an injury triggers 
the limitation periods in Wis. Stat. § 893.55(1) reflects that 
an injury is an element of a medical malpractice claim.  A claim 
for medical malpractice, as all claims for negligence, requires 
the following four elements: (1) a breach of (2) a duty owed (3) 
                     
3 The phrase the "discovery of an injury" as used herein 
also embraces that part of Wis. Stat. § 893.55(1)(b) which 
includes not only the discovery of an injury, but that point in 
time when, in the exercise of reasonable diligence, the injury 
should have been discovered.  
No. 
99-1810 
 
 
9 
that results in (4) an injury or injuries, or damages.  See 
Nieuwendorp v. American Family Ins. Co., 191 Wis. 2d 462, 475, 
529 N.W.2d 594 (1995).  In short, a claim for medical 
malpractice requires a negligent act or omission that causes an 
injury.  
¶18 Here, there is no dispute that the alleged negligence 
is an "omission" under Wis. Stat. § 893.55(1)the failure to 
correctly diagnose the cause of Jennifer's headaches.  However, 
Skemp contends that the alleged misdiagnosis, or misdiagnoses, 
is not only the omission, but also the injury that triggers the 
statute of limitations in § 893.55(1)(a). 
¶19 If, as Skemp suggests, the alleged misdiagnosis is 
both 
the 
negligent 
omission 
and 
the 
injury, 
then 
the 
introductory paragraph of Wis. Stat. § 893.55(1) would read, 
unintelligibly, that "[a]n action to recover damages for [an 
omission] arising from . . . any omission by  . . . a person who 
is a health care provider," etc.  Also, if § 893.55(1)(a) were 
constructed based upon Skemp's contention that a negligent 
omission was also the injury, then both the injury and discovery 
rules of accrual in § 893.55(1) would be changed into a 
negligence-based rule of accrual.  A medical malpractice claim 
would then have to be filed within the later of three years from 
the date of the omission or one year from the discovery of the 
omission. 
¶20 The legislature did not intend that "omission" and 
"injury" would be so conflated.  The plain language of Wis. 
Stat. § 893.55(1)(a) indicates that it is not the negligence, 
No. 
99-1810 
 
 
10
but the injury resulting from the negligent act or omission 
which initiates the limitations period.  It is evident from the 
face of § 893.55(1) that a medical malpractice claim accrues 
when there is an injury, or the discovery thereof, which arose 
from an omission by a health care provider.  This corresponds 
with the long-standing common law rule that a tort claim does 
not accrue until there is an injury. 
 
We have held that the time of the negligent act alone 
is not the key to accrual of tort claims.  . . .  A 
tort claim is not capable of enforcement until both a 
negligent 
act 
and 
an 
accompanying 
injury 
have 
occurred.  Although the negligence and resulting 
injury are often simultaneous, occasionally an injury 
will not be sustained until a subsequent date.  
Therefore, we have held that tort claims accrue on the 
date of injury. 
Hansen, 113 Wis. 2d at 554 (internal citations omitted). 
¶21 Here, we have a case wherein the alleged negligence 
and the resulting injury did not occur concurrently.  The 
alleged negligence——the failure to correctly diagnose the source 
of Jennifer's headaches, preceded the resulting injury——the 
rupture 
of 
the 
AVM 
and 
subsequent 
hemorrhaging. 
 
Skemp 
effectively contends that the negligence and injury occurred 
simultaneously, as evidenced by Jennifer's continued headaches. 
 However, Jennifer's headaches were the condition that existed 
both before and after Skemp examined and diagnosed her.  
No. 
99-1810 
 
 
11
Consequently, Skemp's failure to properly diagnose the headaches 
could not have caused those headaches.4 
 
In every misdiagnosis case, the patient has some type 
of medical problem at the time the physician is 
consulted.  But the injury upon which the cause of 
action is based is not the original detrimental 
condition; it is the injury which later occurs because 
of the misdiagnosis and failure to treat. 
St. George v. Pariser, 484 S.E.2d 888, 891 (Va. 1997). 
¶22 In St. George v. Pariser, Dr. Pariser had performed a 
biopsy on a mole of Linda St. George on June 13, 1991.  He 
diagnosed the mole as benign.  In March 1993, St. George went to 
a plastic surgeon about removing the mole, and the surgeon 
requested Pariser's records.  Pariser again reviewed the tissue 
sample of the mole and then diagnosed it as cancerous. Id. at 
889.  However, by that time, the cancer, a malignant melanoma, 
had invaded St. George's dermis, where it was potentially fatal. 
 Id. at 891. 
¶23 On October 21, 1993, St. George filed suit against 
Pariser.  Id.  St. George moved the trial court to find, as a 
matter of law, that her action was timely under Virginia's 
statute of limitations which bars any action that is filed two 
years after the date of injury.  Id. at 890.  The trial court 
declined to make such a finding and submitted the question to 
the jury, which found the action untimely.  Id.  St. George 
                     
4 It is noteworthy that Skemp's counsel conceded, correctly, 
during oral argument, that as of December 21, 1994, the day 
after Jennifer saw Dr. Updegraff, Jennifer's medical malpractice 
claim had not yet accruedeven though that is the date Skemp 
contends that the statute of limitations began to run.    
No. 
99-1810 
 
 
12
appealed contending that the injury was not the cancer she had 
when she consulted Dr. Pariser.  The Virginia Supreme Court 
agreed: 
 
St. George's actionable injury was not the generic 
disease of cancer or the cancer "in situ" which she 
had when she sought evaluation of the mole in 1991.  
Pariser's negligence could not have been the cause of 
that medical condition.  St. George's injury was the 
change in her cancerous condition which occurred when 
the melanoma altered its status as "melanoma in situ," 
a 
biologically 
benign 
condition, 
to 
"invasive 
superficial 
spreading 
malignant 
melanoma" 
in 
the 
dermis which allowed the melanoma cells to metastasize 
to other parts of the body.  At this point, St. 
George's cancer, according to the expert testimony, 
was no longer 100 percent curable because the cancer 
could metastasize and recur. 
Id. at 891.  Given that the evidence indicated that the melanoma 
invaded the dermis after January 1992, the Virginia Supreme 
Court concluded that Pariser had not proven that St. George's 
action which was filed less than two years later, was untimely. 
 Id. at 892. 
¶24 In concluding that Pariser's misdiagnosis was not the 
injury that triggered the statute of limitations, the Virginia 
Supreme Court relied upon a number of cases wherein the 
actionable injury was that injury caused by the misdiagnosis, 
not the condition for which the patient initially sought medical 
treatment. 
 
[I]n Lo v. Burke, the actionable injury was not the 
cyst the plaintiff had when she went to the doctor, 
although this was a medical problem which should have 
been treated.  The injury at issue was the cancer 
which developed from the cyst.  249 Va. at 315-17, 455 
S.E.2d at 12-13.  Similarly, in Jenkins v. Payne, 251 
No. 
99-1810 
 
 
13
Va. 122, 465 S.E.2d 795 (1996), the injury was the 
wrongful death of a patient who presented to the 
physician with a cancerous condition which was not 
diagnosed or treated before the condition became 
terminal.  See also Renner v. Stafford, 245 Va. 351, 
429 S.E.2d 218 (1993) (actionable injury was condition 
caused by improper treatment rendered because of 
misdiagnosis).  "Where a medical malpractice claim is 
based on a misdiagnosis or failure to diagnose a 
condition, the 'injury'  . . .  is the development of 
the problem into a more serious condition which poses 
greater danger to the patient or which requires more 
extensive treatment."  DeBoer v. Brown, 138 Ariz. 168, 
673 P.2d 912, 914 (Ariz. 1983). 
St. George v. Pariser, 484 S.E.2d at 891. 
¶25 Although a decision from the Virginia Supreme Court is 
certainly not binding precedent for this court, the reasoning 
therein is persuasive.5  A misdiagnosis, in and of itself, is 
not, and cannot, be an actionable injury.  The misdiagnosis is 
the negligent omission, not the injury.  The actionable injury 
arises when the misdiagnosis causes a greater harm than existed 
at the time of the misdiagnosis.  This comports with Wis. Stat. 
§ 893.55(1), i.e., that the "injury arising . . . from any 
omission" instigates the limitations period, not the omission.   
¶26 Skemp 
contends 
that 
there 
is 
authority 
that, 
notwithstanding 
the 
unambiguous 
language 
of 
Wis. 
Stat. 
§ 893.55(1), a misdiagnosis, without more, is an injury that 
results in an accrual of a medical malpractice claim:  Koschnik 
                     
5 We have previously followed the guidance and reasoning of 
the Virginia Supreme Court in the area of medical malpractice.  
See Tamminen v. Aetna Cas. & Sur. Co., 109 Wis. 2d 536, 555-56, 
327 N.W.2d 55 (1982) (followed Virginia cases in determining 
what triggers the limitations period where there is a continuing 
course of negligent treatment).  
No. 
99-1810 
 
 
14
v. Smejkal, 96 Wis. 2d 145, 153, 291 N.W.2d 574 (1980); Elfers 
v. St. Paul Fire & Marine Ins. Co., 214 Wis. 2d 499, 571 N.W.2d 
469 (Ct. App. 1997); and Webb v. Ocularra Holding, Inc., 232 
Wis. 2d 495, 606 N.W.2d 552 (Ct. App. 1999).  However, insofar 
as these cases suggest that a medical malpractice claim accrues 
before there is an injury that has resulted from a misdiagnosis—
—a negligent omission, these cases run counter to long-standing 
precedent that a cause of action does not accrue unless there is 
an injury that has resulted from the alleged negligence.  
 
It is well settled that a cause of action accrues when 
there exists a claim capable of enforcement . . .  .  
A party has a present right to enforce a claim when 
the plaintiff has suffered actual damage, defined as 
harm that has already occurred or is reasonably 
certain to occur in the future.  
Pritzlaff v. Archdiocese of Milwaukee, 194 Wis. 2d 302, 315, 533 
N.W.2d 780 (1995) (internal citations omitted).    
¶27 In Koschnik, Marie Koschnik alleged that she fractured 
her spine in an automobile accident and that she was injured as 
a result of Dr. Smejkal's failure to diagnose the fracture: one, 
"the fracture remained untreated, causing her personal injury;" 
and two, Koschnik relied upon Smejkal's report that failed to 
note the fracture to settle her claims, to her detriment, 
against the other party to the accident.  96 Wis. 2d at 148.  
Koschnik commenced her action on September 22, 1976.  Id. at 
147.  The court concluded that the action was time-barred 
because it was not brought within the three-year limitation 
period that applied to medical malpractice actions at that time. 
 Id. at 152-53.   
No. 
99-1810 
 
 
15
¶28 Koschnik is first distinguishable because it arose 
under a different statutory scheme.  At the time that Koschnik 
brought her claim, in 1976, there was no specific limitations 
statute for medical malpractice actions.  Instead, medical 
malpractice actions were brought under a personal injury 
limitations statute, Wis. Stat. § 893.205.6  Id. at 146.  Section 
893.205 provided that "[a]n action to recover damages for 
injuries to the person for such injuries sustained on and after 
July 1, 1955 . . . ." must be brought within three years after 
the cause of action accrued.  Id. at 146 n.1; see also Rod v. 
Farrell, 96 Wis. 2d 349, 350-51, 291 N.W.2d 568 (1980).  The 
legislature did not dictate the time of accrual of claims 
brought under § 893.205, as it later did in § 893.55(1).  See 
Hansen, 113 Wis. 2d at 559.  Instead, this court determined when 
a medical malpractice claim accrued under § 893.205.  
 
The word accrued is not defined by statute.  This 
court has held that a cause of action for personal 
injuries due to medical malpractice accrues, and 
therefore the statute of limitation begins to run, "at 
the time the negligent act occurs with accompanying 
injury."  Peterson v. Roloff, 57 Wis. 2d 1, 4, 203 
N.W.2d 699 (1973).  See also Reistad v. Manz, 11 
Wis. 2d 155, 105 N.W.2d 324 (1960), McCluskey v. 
Thranow, 31 Wis. 2d 245, 142 N.W.2d 787 (1966), Volk 
v. McCormick, 41 Wis. 2d 654, 165 N.W.2d 185 (1969), 
and Olson v. St. Croix Valley Memorial Hospital, 55 
Wis. 2d 628, 201 N.W.2d 63 (1972). 
                     
6 Wisconsin Stat. § 893.205 was amended and renumbered as 
Wis. Stat. § 893.54, effective July 1, 1980.  Ch. 323, Laws of 
1979.   
No. 
99-1810 
 
 
16
Rod v. Farrell, 96 Wis. 2d at 352-53.7  Since Koschnik, the 
common law rule of accrual has been replaced with § 893.55(1), 
rendering Koschnik of little precedential value.  
¶29 Koschnik is also of little precedential value because 
its conclusion runs counter to the cases it relies upon.  
Without providing any reasoning, Koschnik summarily concluded 
that "under our established construction of sec. 893.205, 
Stats., in medical malpractice cases, the cause of action 
accrued at the time of the misdiagnosis.  The injury to Marie 
Koschnik became fixed on that date."  96 Wis. 2d at 153.  
Koschnik then cites to the same cases that Rod v. Farrell 
did Peterson, Reistad, McCluskey, Volk, and Olson.  However, as 
noted above, these cases all held that the cause of action 
accrued when there was a negligent act accompanied by an injury. 
In concluding that Marie Koschnik's claim accrued at the time of 
the misdiagnosis, without specifying the injury caused by the 
misdiagnosis, 
Koschnik 
apparently 
concluded 
that 
the 
                     
7 These cases were all overruled in part by Hansen v. A.H. 
Robins, 113 Wis. 2d 550, 560, 335 N.W.2d 578 (1983) when Hansen 
adopted the discovery rule of accrual for personal injury 
actions for which there was not already a legislatively-created 
discovery rule.  Wisconsin Stat. § 893.55(1)(b) is such a 
legislatively-created discovery rule for medical malpractice 
actions.  Id. at 557.  For other personal injury actions, those 
governed by the personal injury statute of limitations in 
§ 893.54, the discovery rule of accrual applies.  The discovery 
rule of accrual in such cases is that "a cause of action does 
not accrue until the nature of the injury and the causeor at 
least a relationship between the event and the injuryis or 
ought to have been known to the claimant."  Borello v. U.S. Oil 
Co., 130 Wis. 2d 397, 407, 388 N.W.2d 140 (1986) (emphasis in 
original). 
No. 
99-1810 
 
 
17
misdiagnosis was the injury. (Even though elsewhere, the opinion 
indicated that the alleged misdiagnosis was the not the injury, 
but rather the cause of the alleged injury, which was claimed to 
be the diminution of Koschnik's settlement.  Koschnik, 96 
Wis. 2d at 152.) Accordingly, insofar as Koschnik concluded that 
the misdiagnosis was the injury, it cannot be reconciled with 
the cases upon which it relies, nor with our holding here today. 
 Nor 
can 
Koschnik 
be 
reconciled 
with 
the 
long-standing 
precedent, stretching both before and beyond Koschnik, that 
there is no accrual of a medical malpractice claim until there 
is an injury that resulted from the malpractice.  Any language 
in Koschnik to the contrary is hereby withdrawn. 
¶30 Similarly, insofar as Webb v. Ocularra Holding, Inc., 
232 Wis. 2d 495, 606 N.W.2d 552 (Ct. App. 1999), upon which 
Skemp also relies, suggests that a misdiagnosis is, in and of 
itself, an injury, it is also in error.  In Webb, Roger Webb 
brought a medical malpractice claim against Pearle Vision 
alleging that an eye exam by a Dr. Knutzen should have resulted 
in a diagnosis of a slow-growing brain tumor.  232 Wis. 2d at 
499-500.  The court of appeals concluded that the action was 
untimely filed.  "This action was filed on February 25, 1998.  
The only time Dr. Knutzen saw Webb was on February 23, 1994.  
Thus, any injury caused by Dr. Knutzen could only have occurred 
on the date of Webb's eye examination.  Like the facts in Olson, 
the date of negligence and the date of injury were the same 
date.  Olson, 55 Wis. 2d at 633."  Webb, 232 Wis. 2d at 511.   
No. 
99-1810 
 
 
18
¶31 First, Webb, like Koschnik, does not identify the 
injury caused by the misdiagnosis, but only summarily concludes 
that the negligence and the injury occurred simultaneously.  
Webb, 232 Wis. 2d at 511; see also Koschnik, 96 Wis. 2d at 153. 
 Apparently, as in Koschnik, Webb assumed that the misdiagnosis 
was the injury.  Webb, 232 Wis. 2d at 511.  However, as we have 
previously stated, the misdiagnosis is the negligent act or 
omission.  The misdiagnosis is not the injury.  The misdiagnosis 
may or may not result in an injury; and, that injury may occur 
concurrently, or there may be a delay between the misdiagnosis 
and the injury. 
¶32 In addition, Webb's reliance upon Olson v. St. Croix 
Valley Memorial Hospital, 55 Wis. 2d 628, 201 N.W.2d 63 (1972), 
in suggesting that the alleged misdiagnosis is the actionable 
injury, is misplaced.  In Olson, Judy Olson had received a blood 
transfusion with an incompatible Rh factor in 1962, which, 
allegedly, resulted in the death of two of her children, one 
shortly after birth in 1966 and one stillborn in 1969.  Id. at 
632-33.  The court concluded that the negligent act and the 
injury occurred at the same time; that is, the negligent act, 
the transfusion, caused the injury, Olson's impaired "capacity 
for future childbearing."  Id. at 633. 
¶33 In Olson, there was an affirmative negligent act, the 
improper transfusion, which immediately resulted in an injury to 
Judy Olson.  In contrast, in Webb, the alleged negligence was an 
omission, the failure to diagnose the brain tumor.  But in Webb, 
there was no evidence of an injury that immediately resulted 
No. 
99-1810 
 
 
19
from that misdiagnosis, nor was there evidence of any injury 
that ever resulted from the alleged misdiagnosis, e.g., a 
cancerous condition that became fatal as a result of a 
misdiagnosis.  See St. George v. Pariser, 484 S.E.2d at 891 
(citing Jenkins v. Payne, 465 S.E.2d 795 (Va. 1996)).  Olson has 
no bearing on the misdiagnosis claim in Webb, just as it has no 
bearing on the alleged misdiagnosis claim here. 
¶34 As our long-time 
precedent 
has established, the 
negligence and its result——an injury——should be considered 
separately.  The negligence must cause an injury before there is 
an accrual of a claim.  Meracle v. Children's Serv. Soc'y, 149 
Wis. 2d 19, 26, 437 N.W.2d 532 (1989).  Accordingly, that part 
of Webb that holds that a misdiagnosis is an actionable injury 
is, like that similar part of Koschnik, withdrawn because it is 
in error. 
¶35 Skemp also relies upon Elfers v. St. Paul Fire & 
Marine Ins. Co., 214 Wis. 2d 499, 571 N.W.2d 469 (Ct. App. 1997) 
to contend that a misdiagnosis is an actionable injury.  
However, Elfers supports the court's holding here today rather 
than Skemp's position.   
¶36 Elfers concerns the accrual of a medical malpractice 
claim against a doctor and a radiologist.  Christine Elfers had 
fallen and broken her right arm in 1985 when she was four years 
old.  Id. at 501.  The doctor and the radiologist diagnosed the 
fracture but failed to detect a dislocation in the elbow that 
resulted from that same fall.  Id.  In 1989, Elfers' right arm 
was x-rayed again, and her parents were then told of the 
No. 
99-1810 
 
 
20
dislocation and that it had been caused by the 1985 accident.  
Id.  However, the dislocation was not treated.  Id. at 502.  In 
1993, Christine experienced symptoms related to the dislocation 
and, in 1996, filed an action against the radiologist and 
doctor, among others.  Id.  
¶37 The court of appeals determined the circuit court 
erred in granting the defendants' motion for summary judgment 
which claimed that the action was untimely.  The court of 
appeals held that there was a disputed fact as to the date of 
the injury, which would trigger the limitations period.  Id. at 
505-06.  Regarding Wis. Stat. § 893.55(1), the court of appeals 
noted that "[b]efore the time limitation under this statute 
begins to run, there must first be a negligent act and an injury 
caused by that act."  Id. at 504 (citing Meracle, 149 Wis. 2d at 
26).  The court of appeals could identify the negligent act and 
when it occurred——the failure to diagnose the dislocation in 
1985.  Id. at 504.  However, the court could not determine the 
injury and when it occurred.  Id. at 505-06.  Relying upon our 
decision in Meracle, the court of appeals indicated that there 
was no injury, no enforceable claim for the misdiagnosis, until 
such time "when it became reasonably certain that Christine 
would suffer compensable damages as a result of the negligent 
act."  Id. at 505 (emphasis in original).   
¶38 In Meracle, we held that the adoptive parents had no 
compensable 
injury 
against 
the 
adoption 
agency, 
which 
negligently 
misrepresented 
to 
them 
their 
adopted 
child's 
susceptibility 
to 
Huntington's 
disease, 
until 
the 
child 
No. 
99-1810 
 
 
21
developed the disease.  149 Wis. 2d at 29-30.  At that point, 
"[t]hey could then demonstrate with reasonable medical certainty 
that Erin [the child] would need extensive future medical care." 
 Id.  Similarly, in Elfers, there was no harm to Christine, 
notwithstanding the failure to diagnose the dislocated elbow, 
until she suffered some physical or pecuniary injury as a 
result.  Elfers thus corresponds with our holding here, that 
until the misdiagnosis results in a harm that would not have 
occurred but for the misdiagnosis, there is no injury to trigger 
the running of the statute of limitations.  
¶39 Skemp, however, claims that the following paragraph 
from Elfers supports its contention that a misdiagnosis is a 
medical malpractice injury:  
 
This does not mean that we agree with Christine's 
apparent contention that an asymptomatic dislocated 
elbow is not an injury.  If this medical condition 
will 
inevitably 
result 
in 
some 
disability, 
the 
plaintiff has sustained an injury as of the date the 
failure to diagnose occurred.  Our law does not permit 
a claimant who possesses a cause of action to wait 
until the full effect of the injury has developed 
before filing a claim. 
Id. at 506.  Skemp is incorrect.  Nothing in the above language 
changes the prerequisite that a negligent act or omission, such 
as a misdiagnosis, must cause an injury in order to be 
actionable. If, however, as Elfers suggests, a condition for 
which a patient seeks treatment immediately develops into a more 
serious problem as a result of the misdiagnosis, then the 
patient has sustained an injury caused by the failure to 
No. 
99-1810 
 
 
22
diagnose on the date that there was a failure to diagnose.8  
Indeed, once a claimant has sustained an injury and has an 
enforceable claim, that claimant cannot sit on that claim until 
all consequential damages have come to fruition.  See e.g., 
Nierengarten v. Lutheran Social Serv., 219 Wis. 2d 686, 701, 580 
N.W.2d 320 (1998) (adoptive parents' claims accrued when their 
adopted child was first diagnosed with attention deficit 
disorder, even though extraordinary medical expenses were not 
incurred until later). 
¶40 Nonetheless, Elfers' indeterminate outcome has no 
impact upon our holding.  The injury that resulted from the 
misdiagnosis was in dispute there.  Here, the injury that 
resulted from the misdiagnosis is not in dispute.  There is no 
evidence Skemp's failure to diagnose properly the source of 
Jennifer's headaches would have resulted in an immediate and 
inevitable injury to Jennifer.  Instead, there is evidence that 
suggests the opposite, namely, that the AVM could have been 
treated until shortly before it ruptured. 
¶41 The instant case is more akin to other cases wherein 
the negligent act does not occur concurrently with the injury it 
causes.  See e.g., Meracle, 149 Wis. 2d 19.  However, "[i]n the 
medical malpractice cases so far to come before the Wisconsin 
Supreme 
Court, 
the 
malpractice 
and 
the 
harm 
have 
been 
                     
8 The phrase that "this medical condition will inevitably 
result 
in 
some 
disability" 
indicates 
that, 
in 
certain 
circumstances, the failure to diagnose properly a condition 
results in an immediate injury to the patient.  We have no 
evidence of such circumstances here.  
No. 
99-1810 
 
 
23
coincidental."  Neubauer v. Owens-Corning Fiberglas Corp., 686 
F.2d 570, 573 (7th Cir. 1982).  Yet, there has been a medical 
malpractice case where the malpractice and the injury have not 
been coincidental decided by the court of appeals, Fojut v. 
Stafl, 212 Wis. 2d 827, 569 N.W.2d 737 (Ct. App. 1997).  In 
Fojut, Helen Fojut had a tubal ligation to prevent further 
pregnancies; subsequently, she became pregnant.  Id. at 829.  
The court of appeals rejected, as we do here, the defendants' 
contention that the date of the injury was the date that the 
negligence occurred.  Id. at 831.  The court of appeals instead 
determined that the negligent act was the surgery, and the 
injury that resulted from that negligence was the pregnancy.  
"There was no physical injurious change to Helen's body until 
she became pregnant."  Id.  Similarly, here, there was no 
injurious change as a result of Skemp's misdiagnosis until the 
AVM ruptured, or until the AVM could no longer be treated. 
¶42 If 
a 
negligent 
act 
or 
omission, 
such 
as 
a 
misdiagnosis, 
triggered 
the 
limitations 
period, 
as 
Skemp 
suggests, potential claimants who have not yet been injured 
would be seeking relief for damages that may never occur.  If we 
were to conclude otherwise, we would be "creat[ing] incentives 
for claimants to rush to the courthouse to initiate anticipatory 
litigation."  Sopha v. Owens-Corning Fiberglas Corp., 230 
Wis. 2d 212, 230, 601 N.W.2d 627 (1999).  Extending this 
consideration to the field of health care, if a misdiagnosis was 
an injury that would start the limitations period running, 
patients would have to obtain a second or third opinion or risk 
No. 
99-1810 
 
 
24
losing a claim for medical malpractice.  The result would be to 
drive up health care costs, even though rising health care costs 
prompted the legislature to modify the statute of limitations 
for medical malpractice claims, at least for minors.  See Aicher 
v. Wisconsin Patients Compensation Fund, 2000 WI 98, ¶22, 237 
Wis. 2d 99, 613 N.W.2d 849.  Until there is an injury, any 
damages sought would be speculative.  See Sopha, 230 Wis. 2d at 
229.  Hence the rule that "recovery for damages may be had for 
'reasonably certain injurious consequences of the tortfeasor's 
negligent 
conduct, 
not 
for 
merely 
possible 
injurious 
consequences.'"  Id. at 226-27 (quoting Brantner v. Jenson, 121 
Wis. 2d 658, 663-64, 360 N.W.2d 529 (1985)).  
¶43 Skemp's contention that the alleged misdiagnosis is 
the injury here that triggered the running of the statute of 
limitations ignores the causation element in medical malpractice 
claims.  Skemp must, but does not, establish the necessary 
causal nexus between the alleged misdiagnosis and Jennifer's 
headaches.  See Fischer v. Ganju, 168 Wis. 2d 834, 857, 485 
N.W.2d 10 (1992). Skemp's failure to diagnose the source of 
Jennifer's headaches did not cause the headaches, nor cause the 
AVM.  Jennifer's headaches did not make it reasonably certain 
that she had been injured as a result of the misdiagnosis.  See 
Meracle, 149 Wis. 2d at 27.  Nor did those headaches establish, 
to a reasonable degree of medical certainty, that Jennifer was 
to incur future medical expenses or other harm for which she 
could seek recovery.  Id. at 29-30.  As in St. George v. 
Pariser, 484 S.E.2d 888, the headaches were the initial 
No. 
99-1810 
 
 
25
condition for which Jennifer sought diagnosis and treatment from 
Skemp; they were not the injury that resulted from the 
misdiagnosis.  Indeed, Jennifer's estate is not seeking damages 
for the pain and suffering caused by the headaches, but rather 
for the pain and suffering that resulted from the rupture.  
¶44 Skemp also contends that the misdiagnosis was an 
actionable injury because Jennifer's headaches increased in 
frequency and intensity.  However, it was not shown that the 
misdiagnosis caused more intense and more frequent headaches.  
The headaches, to varying degrees of intensity and frequency 
according to the medical records, existed before and after the 
misdiagnosis. 
¶45 Skemp has not shown that there was an injury that 
resulted from the alleged misdiagnosis that occurred prior to 
March 16, 1995, which would have rendered the action filed here 
untimely.  Accordingly, we conclude that Skemp failed to 
establish a limitations defense to entitle defendants to summary 
judgment.  Moreover, the evidence submitted in opposition to 
Skemp's summary judgment motion indicates that the action was 
timely filed.  The evidence indicates that an actionable injury 
occurred in May 1995.  That actionable injury which resulted 
from the alleged misdiagnosis occurred either at the time that 
Jennifer's AVM ruptured, or at the time that Jennifer's AVM 
could no longer be treated.  Since it is undisputed that an 
actionable injury occurred at some point in May 1995, and this 
No. 
99-1810 
 
 
26
action was filed within three years of that time, on March 16, 
1998, it is timely under Wis. Stat. § 893.55(1)(a).9 
¶46 Skemp makes a final argument, though, that, as a 
policy matter, this action should have been filed one year after 
Jennifer died.  That is, the date of Jennifer's death was the 
last date that the Pauls could have discovered that she had been 
injured by the misdiagnosis, and this action could have been 
filed by then.  Skemp's contention rests upon the discovery rule 
of accrual in Wis. Stat. § 893.55(1)(b) which provides that a 
medical malpractice claim shall be commenced "[o]ne year from 
the date the injury was discovered or, in the exercise of 
reasonable 
diligence 
should 
have 
been 
discovered . . . ."  
However, Skemp ignores the policy reflected in the introductory 
paragraph of § 893.55(1), that the action "shall be commenced 
within the later of: (a) Three years from the date of the 
injury, or (b) One year from the date the injury was discovered 
[etc.]."  (Emphasis added.)   
¶47 Typically, the discovery rule of accrual embodied in 
Wis. 
Stat. 
§ 893.55(1)(b) 
extends 
the 
accrual 
time, 
specifically, where the negligence and the injury occurred at 
the same time, but the injury was latent.  See Claypool v. 
                     
9 Our holding rests solely upon the construction of Wis. 
Stat. § 893.55(1).  We need not, and do not, rely upon the 
"continuing course of negligent treatment" doctrine this court 
adopted in Tamminen, 109 Wis. 2d 536, to determine whether this 
action was timely or not.  Consequently, we need not consider 
whether the statements of Jennifer's mother and boyfriend are 
admissible, since they were offered only in support of applying 
that doctrine here.  
No. 
99-1810 
 
 
27
Levin, 209 Wis. 2d 284, 292-93, 562 N.W.2d 584 (1997).  Section 
893.55(1)(b) allows a claimant to bring a medical malpractice 
claim where an injury was discovered more than three years after 
the injury occurred, so long as the action is brought within one 
year from the date of the discovery of the injury, or within one 
year of when, with the exercise of reasonable efforts, the 
injury should have been discovered, and no "more than 5 years 
from 
the 
date 
of 
the 
act 
or 
omission." 
 
Wis. 
Stat. 
§ 893.55(1)(b). 
¶48 We would be remiss if we failed to note that in 
medical malpractice matters, a tension between the injury rule 
and the discovery rule of accrual arises in those cases where 
there is a lengthy delay between the negligent act or omission 
and the resulting injury.  Under the discovery rule of accrual 
in Wis. Stat. § 893.55(1)(b), "an action may not be commenced 
under this paragraph more than 5 years from the date of the act 
or omission."  The injury rule of accrual apparently does not 
have any similar limitation.  Wis. Stat. § 893.55(1)(a).  
Consequently, a medical malpractice action might be able to be 
timely filed more than five years after the act or omission 
under the injury rule of accrual where, for example, the injury 
occurs more than two years after the negligent act or omission 
and the action is filed within three years from the injury.  In 
contrast, § 893.55(1)(b) clearly bars an action filed more than 
five years after the negligent act or omission even though the 
injury was not discovered until after the five years had passed. 
No. 
99-1810 
 
 
28
See Aicher v. Wisconsin Patients Compensation Fund, 2000 WI 98, 
¶¶10,11, 237 Wis. 2d 99, 613 N.W.2d 849. 
 
¶49 The plain language of Wis. Stat. § 893.55(1) does not 
indicate 
whether 
the 
five-year 
statute 
of 
repose 
in 
§ 893.55(1)(b) applies to actions governed by the injury rule of 
accrual in § 893.55(1)(a).  According to the Legislative 
Reference Bureau's Bill Drafting Manuals that may have been 
referred to when § 893.55(1) was drafted in 1979, paragraphs are 
to be "designated by letters of the alphabet enclosed in 
parentheses."  Wisconsin Bill Drafting Manual at 16 (October 
1976); Wisconsin Bill Drafting Manual, 33 (1979-1980); see also 
§ 35.18 (statute regarding 
printing 
of 
Wisconsin statutes 
provides that "[e]ach paragraph shall be designated by a letter 
or letters enclosed in parentheses").  These drafting manual 
guidelines may indicate that repose limitation may only apply to 
the discovery rule of accrual in paragraph (b).  However, the 
timeliness of an action filed within three years of the date of 
the injury, but more than five years after the negligent act or 
omission is not before us.  The action at issue here was filed 
less than five years after the alleged negligent omission.  We 
nonetheless point out the possible conflict between actions that 
arise under the injury rule of accrual and the discovery rule of 
accrual.  In pointing out this potential conflict, we urge the 
legislature to provide guidance by resolving it.  (Indeed, this 
court has struggled with the impact of injury and discovery 
rules of accrual on medical malpractice claims.  See Aicher, 
2000 WI 98.)  The legislature has, in the past, addressed the 
No. 
99-1810 
 
 
29
problem of the statute of limitations in medical malpractice 
actions.  In so doing, the legislature appropriately considered 
"the policy issues involved."  See Rod v. Farrell, 96 Wis. 2d 
349, 355, 291 N.W.2d 568 (1980). 
¶50 However, in cases such as this one, where the injury 
did not occur at the same time as the negligence, the discovery 
rule of accrual may provide a shorter time in which the claimant 
would bring her claim than the injury rule would provide.  Yet, 
contrary to Skemp's contention, the discovery rule in Wis. Stat. 
§ 893.55(1)(b) was not intended to shorten the time in which a 
claimant had to bring a medical malpractice action.  This is 
evident from the words in the introduction that the claimant 
could choose from the later of the two accrual rules, injury or 
discovery.  In Fojut, the injury accrual rule in § 893.55(1)(a) 
applied because the claim accrued on the date of injury.  212 
Wis. 2d at 830.  The Fojuts were not required to file their 
action one year after they discovered the injury, the pregnancy, 
even though, presumably, they could have.  In fact, that time 
passed before they filed their action.  See id. at 830 n.1.    
¶51 Here, the three-year injury rule of accrual in Wis. 
Stat. § 893.55(1)(a) provided a longer time in which the Pauls 
could file this action than the discovery rule of accrual in 
§ 893.55(1)(b).  The provision in § 893.55(1) that the action 
had to be filed by the "later of" the injury or the discovery 
thereof gave them a choice.  The Pauls were thus entitled to 
file this action within three years of Jennifer's injury, and 
No. 
99-1810 
 
 
30
they did not have to file it sooner, even though they may have 
discovered the injury sooner.10  
IV 
¶52 We make no determination whatsoever regarding the 
merits of the Pauls' claims, or whether they will be able to 
prove the elements of their negligence action.  We have only 
determined the timeliness of the commencement of the action. 
¶53 In summary, we conclude that the alleged misdiagnosis 
in this case was not the injury that triggered the running of 
the limitations period in Wis. Stat. § 893.55(1)(a).  Instead, 
based on the information presented, the injury that resulted 
from the alleged misdiagnosis occurred when the rupture of the 
AVM in Jennifer's brain happened on May 22, 1995, or it occurred 
at that point earlier in May when, more likely than not, 
Jennifer's AVM could not have been successfully treated.  
According to the affidavit of Pauls' expert, proper diagnosis 
prior to May 1, 1995, would have avoided the harm she 
subsequently experienced.  It was this injury that triggered the 
statute of limitations, not the alleged misdiagnosis in November 
or December, 1994.  Consequently, since the instant action was 
                     
10 Skemp makes a related argument that the court of appeals 
decision should be upheld because it reflects public policy 
considerations regarding medical malpractice actions.  However, 
our 
decision 
upholds 
the 
public 
policy 
the 
legislature 
specifically adopted in Wis. Stat. § 893.55(1), wherein the 
legislature both allowed, and limited, actions in relation to 
the injury or the discovery of the injury. 
No. 
99-1810 
 
 
31
commenced on March 16, 1998, it was commenced well within the 
three-year statute of limitations.11       
¶54 The defendants have failed to establish that the 
alleged misdiagnosis was an injury that triggered the running of 
the statute of limitations, which, in turn, would have rendered 
                     
11 The parties themselves did not claim that this action was 
either 
timely 
or 
untimely 
as 
a 
wrongful 
death 
action.  
Accordingly, we do not address that issue, or the contention 
made by amicus, the Wisconsin Academy of Trial Lawyers, that the 
action was timely as a wrongful death action under Wis. Stat. 
§ 893.54(2).  However, this court stated in Rineck v. Johnson, 
155 Wis. 2d 659, 671, 456 N.W.2d 336 (1990) (overruled in part, 
Chang v. State Farm Ins. Co., 182 Wis. 2d 549, 514 N.W.2d 399 
(1994)) that "there is no logical distinction between injury and 
death claims arising out of medical malpractice.  Once medical 
malpractice produces a loss, a remedy exists regardless whether 
the consequence is injury or death."  See also Czapinski v. St. 
Francis Hosp., Inc., 2000 WI 80, ¶18, 236 Wis. 2d 316, 613 
N.W.2d 120.  Notably, though, Rineck and Czapinski dealt with 
damages, not statutes of limitations.  Section 893.55(1) could 
be read as covering wrongful death actions against health care 
providers, that is, those actions "to recover damages for injury 
arising from any treatment or operation performed by, or from 
any omission by, a person who is a health care provider, 
regardless of the theory on which the action is based."  
Potentially, then, there is a conflict where a wrongful death 
action filed against a health care provider which would have 
been timely at the time of the decedent's death and thus timely 
under § 893.54(2), but is barred by § 893.55 because it was 
filed three years after the decedent's death.  This potential 
conflict is not before the court, and has not been briefed or 
argued by the parties.  Apparently, the parties concluded that 
if the medical malpractice claim was timely filed, then the 
wrongful death claim, simultaneously filed and indisputably 
filed within three years of Jennifer's death, was also timely 
filed. 
Also, the parties did not raise, and, accordingly, we do 
not address, any issues regarding the limitations, if any, on 
damages that may be recovered.  See Rineck, 155 Wis. 2d 659; 
Czapinski, 2000 WI 80.  
No. 
99-1810 
 
 
32
this action untimely.  Accordingly, summary judgment in favor of 
the defendants was improper.  The decision of the court of 
appeals, which affirmed that circuit court's granting of summary 
judgment, is hereby reversed, and the action is remanded to the 
circuit court for further proceedings.   
By the Court.—The court of appeals decision is reversed and 
the cause remanded to the circuit court for further proceedings. 
 
 
 
 
 
 
 
  
 
 
No. 
99-1810 
 
 
1