T hi s or derand j udgm enti s notbi ndi ng pr ece dentexce ptundert he * doctr i nes of l aw of the ca s e, r es j udi cat a, and col l at er al es t oppel . I tm aybe c ite d , h o w e v e r, fo r i ts p e rs u a s iv e v a lu e c o n s is te n t w ith F e d . R . A p p . P . 3 2 .1 and 10th C i r . R . 32. 1. FI LED United States C ourt of Appeals

Tenth Circuit 

### S e p t e m b e r18,2007 Elisab eth A. Shumaker Clerk of Court UNI TED S TATES CO URT O F AP PEALS

T E N T H C I R C U I T
FREDERI C K BERN DT,

P lain tiff- A p p e llan t, and E M P L OYE R S M U T UAL I N S U R A N C E CO M P A N I ES; S T ANT ON C OUNT Y ;

P l ai nti ffs - I nterven ors, v. G A R Y K R A M E R , M .D .,

D efe ndant- A ppel l ee. N o. 06- 3096 ( D . C t . N o . 0 3 - C V - 1 2 8 3 - J T M )

(D . K a n .)

ORDE R AND J UDGM E N T * B efor e T A C H A , C h ie fC ir c u it J u d g e , B A L D OCK , and TY M KOVI C H , C i rcui tJudg es.

P lai n ti ff-A p p ell an t Fre d erick B ern d t app ea ls th e D istri ct C o u rt ’s or dergr ant i ng D efe ndant - A ppel l ee G aryK r amerpar t i al s um m aryj udgm ent- 2 -

o n M r. B e rn d t’s c laim o fn e g lig e n c e . W e e x e rc ise ju risd ictio n p u rsu a n t to 2 8 U . S . C . § 1 2 9 1 a n d A F F I R M . I . BA CKGROUND O n Jun e 9, 20 00 , w hil e w orki ng att he S t anton C ou nty , K ansas, L andfi l l , M r . B erndts us t ai ned a c al cane ous fr actur e t o hi s r i ghtheel . T hat d ay , D r. K ram er e x am ined an d tr ea ted M r. B ern d t. T h e fo ll o w ing d ay , D r. K r ameror der ed addi t i onal x- r ay s and C A T s cans , buthe di d not i m m edi at el yper form s ur geryon t he fr actur e bec aus e he w ant ed t o al l ow t i m e fort he s w el l i ng t o decr eas e and the w ound t o s t abi l i ze. O n J une 14, D r. K ra m e r o p e ra te d o n M r. B e rn d t’ s fo o t in o rd e r t o re p a irth e fra c tu re . M r . B erndtw as r el eas ed fr om t he hos pi t al on J une 19. M r. B e rn d t sa w D r. K ra m e r a g a in o n Ju ly6 . F ro m th e tim e o fh is s ur geryunt i l hi s fol l ow - up vi s i ton J ul y6, cl earfl ui d dr ai ned fr om t he w ound i n hi s foot . E ven though he bel i eved hi s footw as i nfec t ed, he t h o u g h tt h e d r a i n a g e wa s a n o r m a l c o n s e q u e n c e o ft h e s u r g e r y . S o m e t i m e a fte r J u ly 6 , h o w e v e r, t h e flu id a p p e a re d y e llo w a n d s e e m e d to c o n ta in p u s . W hen M r . B erndts aw D r . K r ameragai n on J ul y18, t he doct ort ol d hi m t hat hi s w ound w as i nfec t ed. A coupl e day s l at er , on J ul y20, D r . K r amerexami ned M r . B erndt agai n. W hen D r . K r amerm ani pul at ed hi s foot , bl ack mat er i al , as w el l as pus , w as r el eas ed fr om t he w ound. D r . K r amers entM r . B erndtt o t he- 3 -

h o sp it al th at sam e d ayto rec eive a sh o t fo r th e infec ti o n . A t th is t im e, M r. B erndtw as veryconce r ned abouthi s w ound, w hi ch he c ont i nued t o thi nk w as i nfec t ed. O n J ul y28, M r . B erndtw as aw ar e thatthe w ound w as dr ai ni ng cons t ant l yand thatt he i nfec t i on r emai ned. T he fl ui d dr ai ni ng fr om t he w ound neveragai n appea r ed cl ear , buti ns t ead tur ned r ed and pus - col or ed. I n hi s depos i t i on, M r . B erndtacknow l edged thathe w as w or r i ed aboutD r . K r amer ’ s car e dur i ng t hi s t i m e, butthatD r . K r amer al w ay s r eas s ur ed hi m and expl ai ned t o M r . B erndt ’ s s at i s fac t i on t hathe knew w hathe w as doi ng. O n A u g u st 4 , D r. K ra m e r o p e ra ted a g a in o n M r. B e rn d t’s fo o t to i r r i gat e and a er at e the w ound. A cul tur e done thatdayr evea l ed the pr es ence o f p seu d o m o n as, th e b ac teri a c au sing the in fe cti o n . A cc o rdin g to M r. B erndt , D r . K r amert ol d hi m t hatthi s bact er i a w as j us ta “footbug, ” and he s h o u ld n o t w o rr ya b o u t it. B eca us e D r . K r amerw oul d nots ayhow bad the i nfec t i on w as , St ant on C o u n ty ’s w o rk e rs’ c o m p e n sa tio n c a rrie r se n t M r. B e rn d t to se e D r. G ilb e rt, anotheror t hopedi c s ur geon, on Sept ember1. I n hi s depos i t i on, M r . B erndt t es t i fi ed thatD r . G i l ber tt ol d hi m he had a “verybad i nfec t i on, ” w hi ch he w oul d “t ake t o t he gr ave w i t h” hi m . M r . B erndtexpl ai ned thathe under s t ood t hi s t o m ean that , al t hough t r eatm entm ay“puti tt o s l eep, ” the in fe c tio n w a s “ g o in g to a lw a y s b e th e re ” a n d “ e v e n a b a d c o ld c o u ld w a k e it- 4 -

up. ” H e al s o t es t i fi ed thatD r . G i l ber ts ai d thathe mi ghthave j us t“l eftthe fo o t” a n d n o t p e rfo rm e d th e su rg e ry , b u t h e in d ica ted th a t w h e th e r to o p era te i s a “ d o ctor’s d ec isi o n . ” In ad d it ion , M r. B ern d t t esti fied that D r. G i l ber tdi d notcr i t i ci ze D r . K r amer ’ s car e, i ndi cat i ng i ns t ead thatthe a n tib io tic s D r. K ra m e r h a d p re s c ri b e d “ s h o u ld d o th e tr ic k .” O n O c to b e r 1 7 , D r. K ra m e r r e fe rr e d M r. B e rn d t to D r. P e te ri e , a p h y sici an sp ec ial izi n g in infec ti o u s d isease . D u ri n g h is ex am ination o f M r. B erndton O ct ober24, D r . Pet er i e t ol d M r . B erndtthathe had pe r m anent t i nni tus ( i . e. , r i ngi ng i n hi s ear s ) and pos s i bl e ki dneydamage as a r es ul tof an ant i bi ot i c, T obr amy ci n, admi ni s t er ed byD r . K r amert o tr eatthe i nfec t i on fro m A u g u st 1 5 to S e p tem b e r 1 2 . A c c o rd in g to M r. B e rn d t, D r. P e ter ie r ecomm ended thathi s footbe amput at ed bec aus e i tw as br oken s o badl ythat it w a s n o t “ w o rt h a d a rn ,” e v e n ifth e in fe c tio n c o u ld b e tr e a te d . M r . B erndtcont i nued t o s ee D r . K r amerfortr eatm entthr ough February2001. T hats ame m onth, he w as exami ned byD r . Shi el ds , w ho concl uded thatM r . B erndthad fl ui d w i t hi n the bone s ur r oundi ng t he cal cane ous fr actur e cons i s t entw i t h an i nfec t i on. She pr es ent ed M r . B erndt w i t h thr ee t reatm ent opt i on s, i ncludi ng am pu t at i on . M r. B erndtcho se amput at i on, r athert han cont i nui ng t o fi ghtthe i nfec t i on, and on M ar ch 7, 2 0 0 1 , h is le g w a s a m p u ta te d ri g h t b e lo w th e k n e e .- 5 -

O n O ct ober24, 2002, M r . B erndtfi l ed a pe t i t i on r eques t i ng t he c o n v e n in g o fa m e d ica l m a lp ra c tice sc re e n in g p a n e l p u rsu a n t to K a n . S tat. A nn. § 65- 4901. T he fol l ow i ng J ul y , the part i es agr eed t o di s m i s s the s cr eeni ng panel . A nd on A ugus t5, 2003, M r . B erndtfi l ed s ui ti n fede r al di s t r i ctcour t , as s er t i ng di ver s i t yj ur i s di ct i on and s eeki ng damages r es ul t i ng fro m D r. K ram er’s all eg ed n eg li g en ce . T h e D istri ct C o u rtg ran ted D r. K ra m e r’s m o tio n fo r p a rtial s u m m a ryju d g m e n t, fin d in g M r. B e rn d t’s c laim fordamages r es ul t i ng fr om hi s i nfec t i on barr ed bya tw o- y ears t atut e of lim ita tio n s u n d e r K a n s a s la w . See K an. St at . A nn. § 60- 513( a) ( 7) . T he c o u rt su b se q u e n tlyd e n ied M r. B e rn d t’s m o tio n fo r re c o n sid e ra tio n , b u t it gr ant ed M r . B erndtl eave t o fi l e an i nt er l ocut or yappea l pur s uantt o 28 U . S. C . § 1292( b) , w hi ch thi s C our tdeni ed. A ft erthe part i es s uppl ement ed the re co rd w ith ad d it ion al fa cts, the D istri ct C o u rtg ran ted D r. K ram er’s m ot i on forpar t i al s um m aryj udgm enton t he i s s ue of w hetherany s ubs equent , i nt erveni ng negl i gentact i ons occurr ed on oraft erO ct ober24, 2 0 0 0 , w h ic h le d to th e a m p u ta tio n o fM r. B e rn d t’ s lo w e r r ig h t e x tr e m ity. A ft ert he courtent er ed s um m aryj udgm enton t hi s i s s ue, the onl yr emai ni ng i s s ue w as M r . B erndt ’ s cl ai m fordamages bas ed on the t i nni tus i nj ur y . T he par t i es r eac hed a s et t l ementon t hi s i s s ue i n February2006, l eavi ng no fur t heri s s ues fort r i al . M r . B erndtnow appea l s the D i s t r i ctC our t ’ s gr antof s um m aryj udgm enti n D r . K r amer ’ s favorw i t h r es pectt o hi s cl ai m forI n O ct ober2006, t he D i s t r i ctC our tdeni ed M r . B erndt ’ s R ul e 59( e) 1 m ot i on t o al t eroramend t he court ’ s entr yof s um m aryj udgm enton t he i s s ue o fin te rv e n in g n e g lig e n t a c ts le a d in g to th e a m p u ta tio n . See F e d . R. Ci v . P. 59( e) . M r . B erndtappea l s al l fourdi s t r i ctcourtor der s : t he fi r s tor der g ran ti n g D r. K ram er p arti al su m m aryjud g m en t, the o rde r de n y ing M r. B ern d t’ s su b seq u en t m o ti o n to rec o n side r th is ord er, th e o rde r gra n ti n g D r. K r amers um m aryj udgm enton t he i s s ue of i nt erveni ng negl i gentact s , and t he s ubs equentor derdeny i ng M r . B erndt ’ s R ul e 59 mot i on. A l t hough he ap p ea ls al l fo u r ord ers, he o n lyarg u es o n e issu e o n ap p ea l. In h is brief, M r. B erndtdoes n o t ar gue thats ubs equent , i nt erveni ng act s occurr i ng on oraft er O ct ober24, 2000, l ed t o t he amput at i on. I n addi t i on, he ac know l edges t hat t he i nj ur ygi vi ng r i s e t o damages i s t he i nfec t i on t hatl ed t o t he amput at i on, n o t th e a m p u tat ion it self. T h e o n lyissue o n ap p ea l i s the refo re w h ethe r M r. B erndt ’ s cl ai m fordamages r es ul t i ng fr om t he i nfec t i on i s barr ed byt he K ansas st atute of l i m i t at i on s. - 6 - d a m a g e s re su lti n g fro m th e b a c ter ial in fe c tio n . T h e so le is su e o n a p p e a l is w hetherM r. B erndt ’s cl ai m i s barr ed b ythe K ansas st atute of l i m i t at i on s. 1 I I . DI S C U S S I O N W e r evi ew a di s t r i ctcourt ’ s gr antof s um m aryj udgm entde novo. B r adl ey v . Val
- Mej i as , 3 7 9 F .3 d 8 9 2 , 8 9 6 (1 0 th C ir. 2 0 0 4 ). A m o v in g p a rty i s ent i t l ed t o s um m aryj udgm enti f the r ecor d “s how [s ] t hatt her e i s no genui ne i s s ue as t o anym at er i al fac t . ” Fed. R . C i v. P. 56( c) . I n r evi ew i ng t he r ecor d, “w e vi ew t he evi dence and dr aw r eas onabl e i nfer ence s t her efr om i n t he l i ghtm os tfavor abl e t o t he nonmovi ng par t y . ” B r adl ey , 379 F. 3d at 897 ( quot at i on om i t t ed) . W e al s o r evi ew a di s t r i ctcourt ’ s i nt erpr et at i on of s ta te la w d e n o v o . Id. A . K ans as St atut e of Li m i t at i ons- 7 -

G ener al l y , underK ans as l aw , a pl ai nt i ff mustfi l e a medi cal m a lp ra c tic e a c tio n w ith in tw o y e a rs o fth e a c t a lle g e d ly ca u s in g th e inju ry. K an. St at . A nn. § 60- 513( a) ( 7) . B uti f the pl ai nt i ff’ s i nj ur yi s not “r eas onabl yas cert ai nabl e” a tt he t i m e of the al l eged ne gl i gence , the l i m i t at i ons per i od does notbegi n t o run unt i l “the fa ctof i nj ur ybecomes r eas onabl yas cert ai nabl e”: A c a u se o fa c tio n a risin g o u t o fth e re n d e rin g o fo r th e fa ilu re to r enderpr ofes s i onal s ervi ces bya hea l t h car e pr ovi ders hal l be deemed t o have a ccrued atthe t i m e of the occ ur r ence of the ac t gi vi ng r i s e t o t he ca us e of a ct i on, unl es s the fa ctof i nj ur yi s not re a so n a b lya sc e rta in a b le u n til so m e tim e a fter th e in iti a l ac t, t hen the per i od of l i m i t at i on s hal l notcomm ence unt i l the fa ctof t h e i nj u r y b e c o m e s r e a s o n a b l y a s c e r t a i n a b l e t o th e i nj u r e d p a r t y, buti n no events hal l s uch an a ct i on be comm ence d m or e than foury ear s bey ond t he t i m e of the ac tgi vi ng r i s e t o the ca us e of act i on. Id
. § 6 0-513 (c) . T he K ansas Su prem e C ou rthas st at ed thatthe p hrase

“‘ r eas onabl yas cert ai nabl e’ does notm ean ‘ actual know l edge. ’ ” D avi ds on v. D enni ng , 914 P. 2d 936, 948 ( K an. 1996) . R ather , w hetherthe i nj ur yw as rea so n ab lyasc ertaina b le req u ir es th e a p p li ca ti o n o f “ an o bjecti v e stan d ard bas ed upon an e xami nat i on of the s ur r oundi ng ci r cumst ance s . ” P . W. P . v. L . S. & John son C ou nty MentalHealth C tr. , 9 6 9 P .2 d 8 9 6 , 9 0 2 (K a n . 1 9 9 8 ). T ypi cal l y , underK ans as l aw , “obj ect i ve know l edge oft he i nj ur y , not th e e x te n t o fth e inju ry, trig g e rs th e s ta tu te ” in m e d ic a l m a lp ra c tic e c a s e s . Id . B u tw h e n a m e d i c a l p r o c e d u r e o rt r e a t m e n tc a u s e s t h e p l a i n t i ff ’ s i nj u r y,- 8 -

t he K ans as cour t s have a s ked w hen the pl ai nt i ff s houl d have know n thatthe inju ry w a s s u b s ta n tia l o r p e rm a n e n t. See Jo n e s v . Ne u r o s c ie n c e A s s o c s ., Inc ., 8 2 7 P .2 d 5 1 , 5 9 (K a n . 1 9 9 2 ) (h o ld in g th a t a fa c t issu e re m a in e d a s to w h e n th e p lain tiffk n e w h e r c o n d iti o n c a u se d b ysu rg e ryw a s “ p e rm a n e n t, i . e. , su b sta n tial” ); Hechtv. F i rs tNat ’ lB ank & Trus tC o. , 490 P. 2d 649, 655 ( K an. 1971) ( hol di ng t hatpl ai nt i ff’ s “know l edge ofhercondi t i on fr om her ow n o bservat i on , and t hat acquir ed from her phy si ci ans” did no tshow as a m a tter o flaw th a t h e r p o st-tre a tm e n t inju ryw a s s u b sta n tial a n d re a so n a b ly a s c e r t a i n a b l e ) . As t h e s e c a s e s d e m o n s t r a t e , wh e n a n i nj u r yr e s u l t s fr o m a m edi cal pr ocedur e thatr equi r es a r ecove r yper i od, the fa ctof i nj ur yi s not re a so n a b lya sc e rta in a b le u n til th e p lain tiffsh o u ld k n o w th a t th e c o n d iti o n is n o t p a rt o fa n o rm a l re c o v e ry . P e rm a n e n c yin d ica tes th a t th e c o n d iti o n w ill p e rs is t b e y o n d th e re c o v e ry p e ri o d a s a s e p a ra te inju ry. See Cl eve l and v. Wong , 701 P. 2d 1301, 1306 ( K an. 1985) ( not i ng t hat , w i t houtanyi ndi cat i on t h a tt h e c o n d i t i o n wa s p e r m a n e n t , “ [ t ] h e s ym p t o m s o fth e i nj u r ywe r e k n o w n to th e p lain tiff, b u t th e fa c t o finju ryw a s n o t re a so n a b lyo r im m e d iate ly as cert ai nabl e”) . I n s hor t , w hen the i nj ur yi s a r es ul tof a medi cal pr ocedur e, th e inju ryis re a so n a b lya sc e rta in a b le e ith e r w h e n th e p lain tiffh a s re a so n to know t he i nj ur yi s perm anentorw hen the pl ai nt i ff ha s r eas on t o s us pect n e g lig e n c e . See i d. (h o ld in g th a t th e p lain tiff ’s inju ryw a s n o t re a so n a b ly- 9 -

as cert ai nabl e w hen he ha d no r eas on t o s us pectthathi s condi t i ons fol l ow i ng su rge ryw ere p erm an en t or th e re su lto f n eg li g en ce ). F u rth e rm o re , w h e n th e p lain tiffh a s re a so n to k n o w th e inju ryis perm anent , t he ca us e of a ct i on acc rues even i f the pl ai nt i ff doe s notknow t h a ta n e g l i g e n ta c tc a u s e d t h e i nj u r y. S e e Ke lley v . B a rn e tt , 932 P. 2d 471, 477 ( K an. C t . A pp. 1997) ( “I f pl ai nt i ffs w er e al l ow ed t o w ai tt o comm ence s ui tunt i l di r ect l yconfr ont ed w i t h evi dence of negl i gence , the s t atut e of lim itatio n s w o u ld a lm o st n e v e r b e g in to ru n .”). In a p p ly in g th e sa m e sta tu te o f li m it ati o n s to a w ron g fu l dea th ac ti o n , the K an sas S u p rem e C o u rt exp l ai ned w hykn ow l edg e of n egli gen ce i s not r equ i red: “T he p hrase ‘re a so n a b lya sc e rta in a b le’ [ in K a n . S tat. A n n . § 6 0 -5 1 3 (c )] m e a n s th a t a pl ai nt i ff ha s t he obl i gat i on t o r eas onabl yi nves t i gat e ava i l abl e s our ces that c o n ta in th e fa c ts o fth e d e a th a n d its w ro n g fu l c a u s a tio n .” D avi ds on , 914 P. 2d at948. U nl es s “i nform at i on fr om w hi ch the fa ctof dea t h ornegl i gence can be det erm i ned w as ei t herconce al ed, al t er ed, fal s i fi ed, i nacc ur at e, or m i s r epr es ent ed, ” the pl ai nt i ff “ i s char ged w i t h cons t ruct i ve know l edge of i nform at i on t hati s avai l abl e thr ough a r eas onabl e i nves t i gat i on. ” Id. a t 9 4 7 . I n ot herw or ds , once the i nj ur yi s r eas onabl yas cert ai nabl e, the pl ai nt i ff ha s a dutyt o i nves t i gat e w hethernegl i gence caus ed the i nj ur y . T he K ans as Supr eme C our t ’ s i nt erpr et at i on of the s t atut e of l i m i t at i ons i n D avi ds on appl i es notonl yt o w r ongful death act i ons , butt o m edi cal m al pr act i ceB e c a u s e M r . Be r n d tr e q u e s t e d t h e s c r e e n i n g p a n e l mo r e t h a n t w o 2 y e a rs a fter h e c o u ld re a so n a b lya sc e rta in th e inju ry , the D istric t C o u rt d id notdeci de w hethert he l i m i t at i ons per i od w as t ol l ed forpar toral l of the per i od betw een thi s r eques t , on O ct ober24, 2002, and A ugus t5, 2003, w hen h e fi l e d h i s fe d e r a l s u i t . U s i n g e i t h e rd a t e , t h e a c t i o n i s u n t i m e l y. - 10 - a c tio n s a s w e ll. P. W . P . , 96 9 P . 2d at90 1. T he q uest i on i n the i nst ant cas e is, there fo re, w h en M r. B ern d t kn ew o r sho u ld h av e k n o w n that h is i njury (i.e., the in fe c tio n ) w a s p e rm a n e n t, th e re b ytrig g e rin g h is d u tyto in v e stig a te w h e t h e rn e g l i g e n c e c a u s e d t h e i nj u r y. B . W h e n M r. B e rn d t’s Inju ryB e c a m e R e a so n a b lyA sc e rta in a b le B ase d o n o u r rev iew o f th e re co rd, w e a g ree w ith the D istri ct C o u rt ’s det erm i nat i on t hatM r . B erndt ’ s i nj ur yw as r eas onabl yas cert ai nabl e on Sept ember1, 2000, w hen D r . G i l ber texami ned hi m and i nform ed hi m the i nfec t i on w as s er i ous and perm anent . I n hi s depos i t i on, M r . B erndt a c k n o w led g e d th a t D r. G ilb e rt to ld h im th e in fe c tio n w a s p e rm a n e n t at th is poi nti n t i m e; even i f tr eatm entcoul d “puti tt o s l eep, ” D r . G i l ber texpl ai ned t hati tw oul d s t i l l be pr es entand coul d become s ym pt om at i c aga i n i n the futur e. B eca us e he di d notfi l e s ui tw i t hi n tw o y ear s of Sept ember1, 2000, hi s cl ai m fordamages bas ed on thi s i nj ur yi s barr ed bythe s t atut e of l i m i t at i on s. 2 M r . B erndtcont ends , how ever , t hatt he l i m i t at i ons per i od di d not b e g in to ru n u n til , at th e e a rlies t, his e x a m in a tio n b yD r. P e ter ie, w h o to ld h im that am p u tat ion w as a p o ssibil ityan d su g g ested that D r. K ram er’s ca reS p ec ifi ca ll y , M r. B ern d t argu es th at kn o w ledg e o f a co n d it ion ’s 3 perm anenc e i s nott he “de ci s i ve fa ct or ” underK ans as l aw , par t i cul ar l yw hen t he condi t i on i s a for es eea bl e cons equenc e of a m edi cal pr ocedur e. B utt he l ogi cal i m pl i cat i on of thi s ar gum enti s t hata pl ai nt i ff musthave obj ect i ve know l edge ofnegl i gence befor e the l i m i t at i ons per i od begi ns t o run. T hat i s , i f the perm anenc e of M r . B erndt ’ s i nfec t i on di d notm ake the fa ctof i nj ur yr eas onabl yas cert ai nabl e, t he i m pl i cat i on i s t hathi s i nj ur yw as r eas onabl yas cert ai nabl e onl yw hen he ha d r eas on t o s us pecta negl i gent caus e. B utas w e expl ai n above, i n K ans as , a ca us e of a ct i on acc rues w hen t he i nj ur yi s r eas onabl yas cert ai nabl e, even i f the pl ai nt i ff doe s nots us pect a negl i gentcaus e. W hen the i nj ur yi s r eas onabl yas cert ai nabl e, t he pl ai nt i ff “i s char ged w i t h cons t ruct i ve know l edge ofi nform at i on” r egar di ng p o te n tia l n e g lig e n t c a u s e s . See D avi ds on , 9 1 4 P .2 d a t 9 4 7 . - 11 - m a yh a v e b e e n d a m a g in g . M r. B e rn d t ar g u e s th a t K a n sa s la w re q u ire s th a t a pl ai nt i ff ha ve s om e i ndi cat i on thatnegl i gence caus ed the i nj ur ybefor e the l i m i t at i ons per i od begi ns t o run. H ence , beca us e D r . G i l ber tdi d not 3 ques t i on D r . K r amer ’ s car e, he cl ai m s t hatt he negl i gentcaus e w as not r eas onabl yas cert ai nabl e on Sept ember1, 2000. B utas ourpr evi ous di s cus s i on of K ans as l aw demonstr at es , know l edge ofa negl i gentacti s not re q u ire d fo r th e lim itatio n s p e rio d to ru n . W h e n th e inju ryis re a so n a b ly ascer t ai nab l e, a plai nti ff h as a dutyt o invest i gate possi ble negl i gen ce un l ess t he inform at i on necessaryt o d et erm i ne n egli gen ce i s conce al ed o r otherw i se u n re lia b le . P . W . P . , 9 6 9 P .2 d a t 9 0 1 . M r. B e rn d t d o e s n o t ar g u e th a t h e d id n o t h a v e a c c e s s to n e c e s s a ry in fo rm a tio n c o n c e rn in g p o te n tia l n e g lig e n c e . H e ther efor e had a dut yt o i nves t i gat e once he w as aw ar e thathi s i nfec t i on w as p erm an en t ( i. e., o n ce h is i njuryw as re aso n ab lyasc ertaina b le).- 12 -

N e v e r t h e l e s s , t o s u p p o r th i s a r g u m e n tth a tKa n s a s l a w r e q u i r e s s o m e know l edge ofnegl i gence befor e a c aus e of a ct i on acc rues , M r . B erndtci t es ourdeci s i on i n B r adl ey v . Val
- Mej i as , 3 7 9 F . 3 d 8 9 2 ( 1 0 t h Ci r . 2 0 0 4 ) . He not es t hat , i n i nt erpr et i ng t he s ame K ans as s t atut e i n B r adl ey , w e hel d that th e lim itatio n s p e rio d sta rte d to ru n w h e n th e p lain tiffw a s a w a re o fh is d o c to r’ s n e g lig e n t d ia g n o s is . Id. a t 8 9 8 . B u t M r. B e rn d t’s re lian c e o n th is cas e i s m i s pl ace d beca us e, as w e cl ear l ys t at ed i n B r adl ey , the m isd iag n o sis w as th e inju ry. S e e id
. at899 ( des cr i bi ng the pl ai nt i ff’ s i nj ur yas the fa ct th a t th e d o c to r “ w a s n o t p ro p e rlytre a tin g h is c o n d iti o n ” ); see also B r ock v
. G a tz , 2 0 0 7 W L 1 5 8 9 4 1 2 , at * 5 (1 0 th C ir. 2 0 0 7 ) (u n p u b lish e d ) (s tatin g th a t, i n a mi s di agnos i s cas e, t he l egal i nj ur yi s the i m pr opertr eatm entand del ay ed di agnos i s ) . U nl i ke the pr es entcas e, a medi cal pr ocedur e di d not caus e the pl ai nt i ff’ s s ym pt om s i n B r adl ey ; i ns t ead, the defendantphy s i ci an fai l ed t o t r eatan exi s t i ng condi t i on. I n cas es s uch as thi s , the i nj ur y— t he abs ence of ade quat e tr eatm ent

— i s r eas onabl yas cert ai nabl e w hen the p la in tiffh a s re a s o n to k n o w o fth e m is d ia g n o s is . See Bradley , 379 F. 3d at 899 ( not i ng t hatthe pl ai nt i ff w as aw ar e he ha d been i nj ur ed, even though he w a s u n a w a re o fth e “ sc ien tific n a tu re ” o fh is inju rie s, w h e n h e h a d re a so n to ques t i on hi s doct or ’ s di agnos i s ( quot at i on om i t t ed) ) . I ndeed, the pl ai nt i ff c a n n o t d is c o v e r t h e inju ry w ith o u t s o m e in d ic a tio n o fp o s s ib le n e g lig e n c e . C onver s el y , i n t he ca s e befor e us , the i nj ur y( i . e. , the i nfec t i on r es ul t i ng- 13 -

fr om t he s ur gery ) w as r eas onabl yas cert ai nabl e w i t houtanyknow l edge of p o ssible n eg li g en ce . In K an sas, objecti v e k n o w ledg e o f th e inju rytr igg ers th e d u ty to in v e s tig a te a p o te n tia lly n e g lig e n t c a u s e . D avi ds on , 914 P. 2d at 947–48; s e e a ls o P. W . P . , 969 P. 2d at902 ( ci t i ng F r i e n ds Uni v . v . W. R . G r ace & C o. , 6 0 8 P . 2 d 9 3 6 , 9 4 0 ( K a n . 1 9 8 0 ) , i n wh i c h th e Ka n s a s S u p r e m e C our thel d “thatt he s t atut e bega n t o run w hen a ne w r oof w as found t o be lea k in g , n o t w h e n th e e x p e rt late r d isc o v e re d th e c a u se ” ); Kel l ey , 932 P. 2d at476–77 ( r ej ect i ng t he ar gum entthat“the ca us al connec t i on betw een the inju rya n d th e n e g lig e n c e o fth e d e fe n d a n ts m u st h a v e b e e n id e n tifia b le befor e the s t atut e of l i m i t at i ons began t o run”) . M r . B erndtther efor e had a n obl i gat i on t o i nves t i gat e pos s i bl e negl i gence w hen the fa ctof hi s i nj ur yw as r eas onabl yas cert ai nabl e on Sept ember1, 2000. M r. B e rn d t als o a rg u e s th a t h is inju ryw a s n o t re a so n a b ly as cert ai nabl e on Sept ember1, 2000, beca us e D r . K r amercont i nued t o tr eat h im u n til F e b ru a ry2 0 0 1 . A lth o u g h h e a c k n o w led g e s th a t K a n sa s c o u rts h a v e reje c te d th e c o n tin u o u s tr e a tm e n t d o c tr in e , s e e P. W . P . , 969 P. 2d at 903–04, he cont ends thatevi dence of an ongoi ng r el at i ons hi p betw een the pat i entand the defendantphy s i ci an i s r el evanti n det erm i ni ng w hen an inju ry is re a s o n a b ly as c e rt a in a b le , s ee Jones , 827 P. 2d at59. I n s uppor tof t his con t enti on , he cit es Jones v. Neur os ci ence A s s oci at es , Inc. , i n w hi ch the K a n sa s S u p re m e C o u rt h e ld th a t an o n g o in g p a tien t-p h y sic ian re latio n sh ip- 14 -

“i s r el evantupon t he i s s ue of w hen i tw as r eas onabl yappar entt o [the p lain tiff] th a t h e r inju ryw a s p e rm a n e n t, i . e. , s ubs t ant i al . ” Id. I n Jones , how ever , none of the pl ai nt i ff’ s phy s i ci ans t ol d herthathercondi t i on, w h ic h w a s a re s u lt o fs u rg e ry, w a s p e rm a n e n t u n til a fte r s h e file d s u it. Id. at 5 4 . H e r re latio n sh ip w ith th e d e fe n d a n t p h y sic ian s w a s th e re fo re re lev a n t to d e te rm in in g w h e n s h e s h o u ld h a v e k n o w n h e r i nju ry w a s p e rm a n e n t. See i d. at59 ( not i ng t he evi dence r egar di ng the i nj ur y ’ s perm anenc e w as “i nconcl us i ve” a nd t her efor e cr eat ed a que s t i on of fa ctforthe j ur y ) . H er e, h o w e v e r, th e e v id e n c e a s to w h e n th e inju ry ’s p e rm a n e n c e w a s re a so n a b ly asc ertaina b le i s n o t i n d ispu te; M r. B ern d t ack n o w ledg es th at D r. G il b ert t ol d hi m t he i nfec t i on w as perm anenton Sept ember1, 2000. H i s ongoi ng re latio n sh ip w ith D r. K ra m e r is th e re fo re irre lev a n t w ith re sp e c t to th is i s s ue. I n addi t i on t o Jones , M r. B e rn d t ar g u e s th a t h is c a se is a n a lo g o u s to C l eve l and v. Wong , 701 P. 2d 1301 ( K an. 1985) , and Hechtv. F i rs tNat i onal B ank & Trus tC o. , 490 P. 2d 649 ( K an. 1971) . I n bot h thes e ca s es , the K ans as Supr eme C our tnot ed thatthe evi dence pr es ent ed a que s t i on of fa ct a s to w h e n th e inju ry w a s re a s o n a b ly as c e rt a in a b le . C l eve l and , 701 P. 2d at 1 3 0 6 ; Hecht , 4 9 0 P .2 d a t 6 5 5

– 5 6 . B uti n bot h cas es , the pl ai nt i ffs had no rea so n to su sp ec t th at co n d it ion s resu lt ing fro m m ed ical trea tm en t w ere p e rm a n e n t; n o n e o fth e p lain tiffs’ p h y sic ian s h a d in d ica ted th a t th e ir- 15 -

c o n d itio n s w e re p e rm a n e n t o r a re s u lt o fn e g lig e n c e . C l eve l and , 701 P. 2d at 1 3 0 6 ; Hecht , 4 9 0 P . 2 d at 65 5 . C o n v erse ly , M r. B ern d t t esti fied that D r. G ilb e rt to ld h im th a t h e w o u ld ta k e h is in fe c tio n “ to th e g ra v e ” w ith h im . A c c o rd in g to M r. B e rn d t, D r. G ilb e rt in d ica ted th a t trea tm e n t m ig h t “p u t it t o s l eep, ” butt he i nfec t i on w oul d “al w ay s be ther e. ” B eca us e M r . B erndt clea rl yh ad rea so n to k n o w that h is i n fe cti o n w as p erm an en t after see ing D r. G il b ert, n o g en u ine issu e o f m aterial fa ct rem ains as to w h en M r. B ern d t’ s inju ryw a s re a so n a b lya sc e rta in a b le. C o n se q u e n tly , w e fin d th a t th e sta tu te o flim itatio n s b e g a n to ru n o n S e p tem b e r 1 , 2 0 0 0 , an d th e in sta n t ac tio n is t h e r e fo r e u n t i m e l y. I I I . CO N C L U S I O N B eca us e M r . B erndt ’ s caus e of a ct i on i s barr ed byt he s t atut e of lim itatio n s, w e A F F IR M th e D istric t C o u rt’s g ra n t o fsu m m a ryju d g m e n t in favorof D r . K r ameron M r . B erndt ’ s cl ai m fordamages r es ul t i ng fr om t he i nfec t i on. ENTERED FOR TH E CO U R T ,

D eane l l R eec e Tacha C hi ef Ci r cui tJ udge