Title: Jerry Adams; Orville Beavers and Mary Beavers; Phyllis Dexter, Patricia Foshee and Carl Foshee; Deborah Ann Johnson and John Johnson; Darlene and Eddie Kinder; Ludivinia Gallegos Miller; Kenneth Mitchell and Jan Mitchell; Shelia Orrell and Tommy Orrell; Carl Rae and Priscilla Rae; Randy Stewart and Deondra Stewart, David Trusty and Pam Trusty v. James Arthur, M.D.; Allan Gocio, M.D.; Hot Springs Neurosurgery Clinic, P. A.; American Medical International, Inc. d/b/a National Park Medical Center; St. Joseph's Regional Health Center, P.A.

State: arkansas

Issuer: Arkansas Supreme Court

Document:

Jerry ADAMS; Orville Beavers and Mary
Beavers; Phyllis Dexter; Patricia Foshee and
Carl Foshee; Deborah Ann Johnson and John
Johnson; Darlene and Eddie Kinder; Ludivinia
Gallegos Miller; Kenneth Mitchell and Jan
Mitchell; Shiela Orrell and Tommy Orrell;
Carl Rae and Priscilla Rae; Randy Stewart and
Deondra Stewart; David Trusty and Pam Trusty
v. James ARTHUR, M.D.; Allan Gocio, M.D.; Hot
Springs Neurosurgery Clinic, P.A.; American
Medical International, Inc., d/b/a National
Park Medical Center; St. Joseph's Regional
Health Center, Inc.

96-1350; 96-1470; 96-1415; 96-1407; 96-1355; 96-1354; 96-1414; 96-
1406; 96-1409; 96-1408; 96-1405; 96-1365           ___ S.W.2d ___

                    Supreme Court of Arkansas
                Opinion delivered April 30, 1998


1.   Judgment -- summary judgment -- when granted. -- Summary judgment is
     to be granted by a trial court only when it is clear that
     there are no genuine issues of material fact to be litigated,
     and the party is entitled to judgment as a matter of law; once
     the moving party has established a prima facie entitlement to
     summary judgment, the opposing party must meet proof with
     proof and demonstrate the existence of a material issue of
     fact.

2.   Judgment -- summary judgment -- standard of review. -- On appellate
     review, the court determines if summary judgment was
     appropriate based on whether the evidentiary items presented
     by the moving party in support of the motion leave a material
     fact unanswered; the appellate court views the evidence in a
     light most favorable to the party against whom the motion was
     filed, resolving all doubts and inferences against the moving
     party; the appellate court's review focuses not only on the
     pleadings but also on the affidavits and other documents filed
     by the parties; the appellate court only approves the granting
     of the motion when the state of the evidence as portrayed by
     the pleadings, affidavits, discovery responses, and admissions
     on file is such that the nonmoving party is not entitled to a
     day in court, i.e., when there is not any genuine remaining
     issue of material fact and the moving party is entitled to
     judgment as a matter of law.

3.   Limitation of actions -- running of statute of limitations as defense --
     shifting burden. -- When the running of the statute of
     limitations is raised as a defense, the defendant has the
     burden of affirmatively pleading this defense; once it is
     clear from the face of the complaint that the action is barred
     by the applicable limitations period, the burden shifts to the
     plaintiff to prove by a preponderance of the evidence that the
     statute of limitations was in fact tolled.

4.   Limitation of actions -- fraud suspends running of statute of limitations.
     -- Fraud suspends the running of the statute of limitations,
     and the suspension remains in effect until the party having
     the cause of action discovers the fraud or should have
     discovered it by the exercise of reasonable diligence.

5.   Judgment -- summary judgment -- when trial court may resolve fact issues
     as matter of law. -- Although the question of fraudulent
     concealment is normally a question of fact that is not suited
     for summary judgment, when the evidence leaves no room for a
     reasonable difference of opinion, a trial court may resolve
     fact issues as a matter of law.

6.   Physicians & surgeons -- medical malpractice -- proof of knowing
     concealment not always necessary to show fraudulent concealment. -- Proof
     of knowing concealment is not always necessary to establish
     fraudulent concealment.

7.   Limitation of actions -- fraudulent concealment -- requirements for tolling
     statute. -- Regarding fraudulent concealment, no mere ignorance
     on the part of the plaintiff of his rights, nor the mere
     silence of one who is under no obligation to speak, will
     prevent the statute bar; there must be some positive act of
     fraud, something so furtively planned and secretly executed as
     to keep the plaintiff's cause of action concealed or
     perpetrated in a way that it conceals itself; if the
     plaintiff, by reasonable diligence, might have detected the
     fraud, he is presumed to have had reasonable knowledge of it. 

8.   Physicians & surgeons -- medical malpractice -- alleged breach of duty to
     obtain informed consent not equated with fact question as to fraudulent
     concealment. -- The supreme court rejected appellants' contention
     that, in all informed-consent cases, there will always be
     genuine issues of material fact regarding fraudulent
     concealment; the court was unwilling to accept such a
     formulation of fraudulent concealment that would effectively
     eviscerate the two-year limitations period in all informed-
     consent cases where the Medical Malpractice Act established a
     two-year limitations period for medical injury [Ark. Code Ann.
      16-114-203(a)], contemplated actions for lack of informed
     consent [Ark. Code Ann.  16-114-206(b)(1)], and yet did not
     carve out an exception to the limitations period in informed-
     consent cases; to equate an alleged breach of a physician's
     duty to obtain a valid informed consent with a fact question
     concerning fraudulent concealment would effectively destroy
     the limitations period that begins running from the moment of
     medical injury.  

9.   Physicians & surgeons -- medical malpractice -- heart of appellants' case
     was whether consent was informed. -- Although, in the present cases,
     evidence of affirmative misrepresentations, either in
     connection with or subsequent to appellants' surgeries, may
     have created a fact question of tolling the limitations period
     for the jury, fraudulent concealment must go beyond a mere
     failure to obtain an adequate informed consent; it must rise
     to the level of some positive act of fraud, something so
     furtively planned and secretly executed as to keep the
     plaintiff's cause of action concealed, or perpetrated in a way
     that it conceals itself; appellants consented to neck surgery
     involving an implantation, which they received, and the heart
     of their cases was whether or not that consent was informed.

10.  Physicians & surgeons -- medical malpractice -- limitations period --
     affirmative misrepresentation regarding surgery may operate to conceal
     patient's cause of action. --  An affirmative misrepresentation by
     a physician in connection with or after the surgery may
     operate to conceal the patient's cause of action; to hold
     otherwise would necessarily foster an environment of complete
     distrust between patient and physician; such a consequence
     could not have been intended by the General Assembly in
     enacting the two-year limitations period.   

11.  Judgment -- summary judgment -- allegation of fraudulent concealment not
     well suited for. -- An allegation of fraudulent concealment is
     not typically well suited for summary judgment, unless the
     evidence leaves no room for a reasonable difference of
     opinion.

12.  Judgment -- summary judgment for doctors affirmed in appellant A's case.
     doctor's statements did not create fact question as to fraudulent
     concealment. -- The evidence regarding the postsurgery disclosure
     of the use of hydroxylapatite during neck surgery raised a
     factual issue as to whether the procedure was innovative and
     experimental and whether appellee physicians were required to
     advise appellant A prior to obtaining his consent of the
     innovative nature of the operation and the available options
     and dangers involved; the supreme court, however, was unable
     to say that the doctors' alleged omissions in failing to so
     inform appellant A, or the character of the representations
     the doctors actually made, rose to the level of some positive
     act of fraud, something so furtively planned and secretly
     executed as to keep the plaintiff's cause of action concealed,
     or perpetrated in a way that it concealed itself;
     significantly, physician I made no representations concerning
     what sort of material would be used in the surgery; while some
     of physician I's statements were arguably misrepresentations
     about efficacy, they did not rise to the level of affirmative
     representations sufficient to create a fact question with
     respect to fraudulent concealment; the supreme court concluded
     that no fact question existed regarding fraudulent concealment
     and affirmed the grant of summary judgment to appellee
     doctors.

13.  Judgment -- summary judgment for doctors reversed in appellants R and S's
     case -- representation concerning nature of material to be used in surgery
     created fact question as to fraudulent concealment. -- Where physician
     II allegedly told appellant R before neck surgery that he
     would use an "artificial bone" growing in his laboratory, the
     supreme court held that this affirmative statement, an
     arguable misrepresentation concerning the nature of the
     material to be used in the surgery, was at least sufficient to
     create a fact question regarding fraudulent concealment and
     constituted proof leaving room for a reasonable difference of
     opinion as to whether the causes of action of appellants R and
     S were fraudulently concealed; the summary judgment to
     appellee doctors was reversed, and the case was remanded.

14.  Judgment -- summary judgment for doctors reversed in case of appellants B
     and C -- alleged misrepresentation created fact question as to fraudulent
     concealment. -- Where, prior to neck surgery, physician I met
     with appellant B and told him that he would use bone from the
     bone bank, the supreme court, concluding that this was
     evidence of an affirmative act that would have prevented
     appellant B from learning the actual nature of the material
     used in his surgery, held that this alleged misrepresentation
     was sufficient to create a fact question regarding fraudulent
     concealment; the court reversed the grant of summary judgment
     to appellee doctors in the case of appellants B and C and
     remanded the matter. 

15.  Judgment -- summary judgment for doctors affirmed in case of appellants G
     and H -- fact question as to fraudulent concealment not established. --
     The supreme court affirmed the summary judgment to appellee
     doctors in the case of appellants G and H because of the lack
     of evidence of positive acts of fraudulent concealment on the
     part of the doctors; while the additional evidence offered
     undoubtedly raised a factual issue concerning the experimental
     nature of hydroxylapatite, this went to the merits of the
     informed-consent claims and did not rise to the level of
     fraudulent concealment; the court was unable to say that the
     representations allegedly made by the doctors established a
     fact question regarding fraudulent concealment.

16.  Judgment -- summary judgment for doctors affirmed in case of appellants L
     and M -- no representations made concerning material to be used in
     surgery. -- Where, prior to neck surgery, appellant M had a
     telephone conversation with physician I, who did not tell her
     anything about the surgery or what he might use as a graft
     material, and where appellant M did not learn until after she
     had become aware that other lawsuits had been filed and had
     obtained her medical records, that hydroxylapatite had been
     used in her surgery, the supreme court affirmed the grant of
     summary judgment in the case of appellants L and M because of
     the lack of evidence of positive acts of fraudulent
     concealment on the part of appellee doctors; the court noted
     that appellant had assumed that bone from the bone bank would
     be used in her surgery, but the doctors made no
     representations concerning what material would be used; beyond
     the failure to inform, or a mere continuation of this
     nondisclosure, there must have been something more in order to
     create a fact question regarding fraudulent concealment.

17.  Judgment -- summary judgment for doctors reversed in cases of appellants
     E and F, P and Q, N and O, K, and D -- representations created fact
     question as to fraudulent concealment. -- In the cases involving
     appellants E and F, P and Q, N and O, K, and D, the supreme
     court reversed the grant of summary judgment to appellee
     doctors and remanded where the crucial allegations were the
     doctors' alleged representations concerning "synthetic discs"
     and an "artificial hip bone"; a reasonable inference from the
     alleged statements concerning the nature of the material to be
     used was that the material was appropriate for use in the
     spine; thus, the representations at a minimum created a fact
     question concerning fraudulent concealment.   

18.  Judgment -- summary judgment for doctors reversed in case of appellants I
     and J -- representation that material was "not experimental" created fact
     question as to fraudulent concealment. -- Where, in the case of
     appellants I and J, appellant I had knowledge that a
     "synthetic fiber" would be used in her neck, but physician II
     allegedly told her that the material was "not experimental,"
     the supreme court reversed and remanded the grant of summary
     judgment to appellee doctors, holding that the representation
     created a fact question regarding fraudulent concealment.

19.  Judgment -- summary judgment for doctors reversed in case of appellants T
     and U -- appellant T not told material was fractured. -- Where, in the
     case of appellants T and U, physician II examined an x-ray
     during a postsurgery office visit and told appellant T that
     everything looked fine when, in fact, the material inserted
     had already fractured, and where at no time, even after he
     terminated his care with physician II, was appellant T told
     that the material was fractured, the supreme court reversed
     the grant of summary judgment to appellee doctors and remanded
     for further proceedings; there existed genuine issues of
     material fact concerning whether the doctors fraudulently
     concealed appellants T and U's causes of action.

20.  Judgment -- summary judgment for hospitals affirmed on fraudulent-
     concealment claims -- evidence of affirmative conduct lacking. -- With
     regard to fraudulent concealment, the supreme court rejected
     appellants' arguments against appellee hospitals in all cases,
     noting that it was unclear whether appellants had even
     sufficiently pleaded fraudulent concealment against appellee
     hospitals; to the extent that appellee hospitals may have owed
     appellants a duty to obtain their informed consent to the use
     of hydroxylapatite, the court observed that it would affirm on
     the basis that, while there was evidence that appellee
     hospitals knew or should have known of appellee doctors' use
     of the material and its experimental nature, evidence of
     affirmative conduct on the part of appellee hospitals to
     conceal the appellants' causes of action was lacking. 

21.  Torts -- product-liability claims against hospitals not moot. -- The
     supreme court declined to hold that appellants' product-
     liability claims against appellee hospitals were moot; the
     orders of dismissal with the manufacturer in the records
     showed only that the matter had been compromised and settled
     and that the cause against the manufacturer was dismissed with
     prejudice, but the court, not having the benefit of any
     release between the appellants and the manufacturer, would be
     left to speculate concerning the terms of that release, as
     well as the potential viability of cross-claims between the
     parties.

22.  Limitation of actions -- two-year period in Medical Malpractice Act
     supersedes three-year period in Product Liability Act. -- Where the two-
     year statute of limitations found in the Medical Malpractice
     Act conflicted with the three-year limitations period found in
     the Product Liability Act and, for that matter, the same
     limitations period applicable to claims brought pursuant to
     the Strict Liability Act, the supreme court held that the two-
     year limitations period found in the Medical Malpractice Act
     supersedes that found in the Product Liability Act.

23.  Judgment -- summary judgment for hospitals Limitation of actions -- Medical
     Malpractice Act's two-year period governed appellants' product-liability
     claims. -- Although the Product Liability Act, Act 511 of 1979,
     and the Medical Malpractice Act, Act 709 of 1979, were enacted
     in the same legislative session, and an implied repealer is
     not favored, the Medical Malpractice Act, as the latter
     enactment within the session, may be seen as the prevailing
     expression of legislative intent; for that reason, and in
     light of the all-inclusive language used by the General
     Assembly in defining an action for medical injury to encompass
     those actions "whether based in tort, contract, or otherwise,"
     the supreme court concluded that the Medical Malpractice Act's
     two-year statute of limitations governed appellants' product-
     liability claims brought against appellee hospitals and that
     the trial court did not err in granting summary judgment to
     appellee hospitals on appellants' product-liability claims. 

24.  Constitutional law -- challenge to Medical Malpractice Act's statute of
     limitations -- rational-basis standard of review. -- Concerning
     appellants' challenge to the constitutionality of the Medical
     Malpractice Act's statute of limitations, Ark. Code Ann.  16-
     114-203 (1987), the supreme court, acknowledging that the
     statute might more accurately be described as a statute of
     repose, declined to apply strict scrutiny in examining its
     constitutionality and held instead that the applicable
     standard of review was rational basis.

25.  Constitutional law -- equal protection -- rational-basis requirement for
     legislation affording different treatment for different classifications. --
     The constitutional guarantee of equal protection does not
     prohibit legislation affording different treatment for persons
     in different classifications so long as there is a rational
     basis for the different classifications and they have some
     reasonable relation to the objectives of the legislation.

26.  Limitation of actions -- public-policy matter -- General Assembly's
     prerogative. -- Any statute of limitations will eventually
     operate to bar a remedy; the time within which a claim should
     be asserted is a matter of public policy, the determination of
     which lies almost exclusively in the legislative domain; the
     decision of the General Assembly in that regard will not be
     interfered with by the courts in the absence of palpable error
     in the exercise of the legislative judgment; simply put, it is
     the General Assembly's prerogative to set a time in which a
     claim must be brought.

27.  Constitutional law -- rational basis not lacking in Medical Malpractice
     Act's statute of limitations. -- The supreme court was unable to
     say that the limitations period found in section 16-114-203
     lacked a rational basis or deprived a claimant of a
     constitutional right to redress of wrongs or a jury trial.

28.  Constitutional law -- trial court did not err in declining to find Medical
     Malpractice Act's limitations period unconstitutional. -- The supreme
     court concluded that a rational basis existed for the Medical
     Malpractice's Act exception to its limitations period in
     foreign-object cases; the trial court did not err in declining
     to find the limitations period unconstitutional as violative
     of equal protection.


     Appeal from Garland Circuit Court; Tom Smitherman, Judge;
affirmed in part;reversed and remanded in part.
     Boswell, Tucker, Brewster & Hicks, by: George R. Wise, Jr.,
for appellants Jerry Adams; Orville Beavers and Mary Beavers;
Phyllis Dexter; Patricia Foshee and Carl Foshee; Deborah Ann
Johnson and John Johnson; Darlene and Eddie Kinder; Ludivinia
Gallegos Miller; Kenneth Mitchell and Jan Mitchell; Shiela Orrell
and Tommy Orrell; Carl Rae and Priscilla Rae; Randy Stewart and
Deondra Stewart; David Trusty and Pam Trusty.
     Friday, Eldredge & Clark, by: J. Phillip Malcom and Tonia P.
Jones, for appellees James Arthur, M.D.; Allan Gocio, M.D.; Hot
Springs Neurosurgery Clinic, P. A.
     Huckabay, Munson, Rowlett & Tilley, P.A., by: Mike Huckabay
and Beverly A. Rowlett, for appellee American Medical
International, Inc., d/b/a National Park Medical Center in cases
96-1350, 96-1470, and 96-1405.
     Wright, Lindsey & Jennings, by: Edwin L. Lowther, Jr., and Don
S. McKinney, for appellee St. Joseph's Regional Health Center,
Inc., in cases 96-1415, 96-1407, 96-1355, 96-1354, 96-1414, 96-
1406, 96-1409, 96-1408, and 96-1365. 

     Anaabelle Clinton Imber, Justice.
     These twelve cases involve identical core issues.  By
agreement of the parties, the cases were orally argued and
submitted simultaneously.  In the interest of efficiency, we
dispose of them in a single opinion.  All appellants were patients
(or their spouses) of the appellee doctors, Drs. James Arthur and
Allan Gocio.  The appellants underwent anterior cervical fusion
surgeries.  In performing the surgeries, the doctors used
hydroxylapatite, known by the trade name "Orthoblock," as a spacer
in the spine.
     Following their respective surgeries, appellants filed
complaints against the doctors and their clinic, Hot Springs
Neurosurgery Clinic, P.A (the "doctors"), alleging that they were
damaged as a result of the implantation of Orthoblock.  In each
case the complaint was filed more than two years after the
respective surgery.  Appellants sought recovery based on
negligence, battery, fraud, outrage, strict liability, and breach
of warranty.  The hospitals where the surgeries were performed were
also named as defendants.  In three cases, the hospital was
American Medical International, Inc. ("AMI"), while in the
remaining nine cases the hospital was St. Joseph's Regional Health
Center, Inc. ("St. Joseph's").  The manufacturer of Orthoblock,
Calcitek, Inc., was also named as a defendant in all twelve cases.
     The doctors and the hospitals moved for summary judgment in
part arguing that all claims were barred by the limitations period
found in the Arkansas Medical Malpractice Act.  The trial court
agreed and granted summary judgment to the doctors and hospitals
finding that all claims were barred by the two-year limitations
period for medical injury found in the Medical Malpractice Act,
Ark. Code Ann.  16-114-203(a) (Supp. 1997).  The trial court
additionally declined to find that the Medical Malpractice Act was
unconstitutional.  While Calcitek did not join in these motions for
summary judgment, orders of dismissal were entered in these cases
reflecting a settlement with Calcitek.  The present appeals
followed.  We affirm the grant of summary judgment in favor of the
appellee doctors in Adams, No. 96-1350, Johnson, No. 96-1355,
Mitchell, No. 96-1406, and reverse and remand as to the appellee  
doctors in Stewart, No. 96-1405, Foshee, No. 96-1407, Rae, No. 96-
1408, Orrell, No. 96-1409, Miller, No. 96-1414, Dexter, No. 96-
1415, Trusty, No. 96-1365, Kinder, No. 96-1354, and Beavers, No.
96-1470.  As to the appellee hospitals, we affirm the grant of
summary judgment in all cases.  
I.  Fraudulent Concealment.
     The appellants argue that the grant of summary judgment to
the doctors and hospitals was erroneous because genuine issues of
material fact existed as to whether fraud or fraudulent
concealment tolled the limitations periods in each case.  The law
is well settled that summary judgment is to be granted by a trial
court only when it is clear that there are no genuine issues of
material fact to be litigated, and the party is entitled to
judgment as a matter of law.  Wallace v. Broyles, 331 Ark. 58,
961 S.W.2d 712 (1998), supp. opinion on denial of reh'g, Ark.
slip op. March 5, 1998.  Once the moving party has established a
prima facie entitlement to summary judgment, the opposing party
must meet proof with proof and demonstrate the existence of a
material issue of fact.  Id.  On appellate review, this court
determines if summary judgment was appropriate based on whether
the evidentiary items presented by the moving party in support of
the motion leave a material fact unanswered.  Id.  This court
views the evidence in a light most favorable to the party against
whom the motion was filed, resolving all doubts and inferences
against the moving party.  Id.  Our review focuses not only on
the pleadings, but also on the affidavits and other documents
filed by the parties.  Id.  We have further explained that:
     We have ceased referring to summary judgment as [a]
     "drastic" remedy.  We now regard it simply as one of
     the tools in a trial court's efficiency arsenal;
     however, we only approve the granting of the motion
     when the state of the evidence as portrayed by the
     pleadings, affidavits, discovery responses, and
     admissions on file is such that the nonmoving party is
     not entitled to a day in court, i.e., when there is not
     any genuine remaining issue of material fact and the
     moving party is entitled to judgment as a matter of
     law.

Id.
     When the running of the statute of limitations is raised as
a defense, the defendant has the burden of affirmatively pleading
this defense.  First Pyramid Life Ins. Co. v. Stoltz, 311 Ark.
313,