Case Name: Richard and Nancy RAJNOWSKI v. ST. PATRICK'S HOSPITAL, et al.
Court: Louisiana Supreme Court
Jurisdiction: Louisiana
Decision Date: 1990-04-30
Citations: 564 So. 2d 671
Docket Number: No. 89-C-2786
Parties: Richard and Nancy RAJNOWSKI v. ST. PATRICK’S HOSPITAL, et al.
Judges: DENNIS, J., concurs with reasons.
Reporter: Southern Reporter, Second Series
Volume: 564
Pages: 671–682

Head Matter:
Richard and Nancy RAJNOWSKI v. ST. PATRICK’S HOSPITAL, et al.
No. 89-C-2786.
Supreme Court of Louisiana.
April 30, 1990.
Rehearing Denied May 24, 1990.
Lawrence Kullman, Lewis & Kullman, New Orleans, for applicant.
Robert Clements, Stockwell, Sievert, Vic-cellio, Clements & Shaddock, Lake Charles, Charles Boudreaux, Sr., Pugh & Bou-dreaux, Lafayette, for respondent.

Opinion:
MARCUS, Justice.
Richard and Nancy Rajnowski, individually and on behalf of their minor child, Richard Rajnowski, Jr., filed suit against St. Patrick's Hospital and Dr. Floyd Gui-dry, seeking damages for their child's brain damage resulting from alleged negligent medical treatment during the prenatal period and delivery. Each defendant filed an exception of prescription, arguing that plaintiffs' cause of action had prescribed under La.R.S. 9:5628 because suit was filed more than three years after the birth of the child. The trial judge granted defendants' exceptions of prescription dismissing the suit with prejudice. Plaintiffs did not appeal the judgment granting St. Patrick's Hospital's exception of prescription; therefore, the judgment is definitive as to St. Patrick's Hospital. Plaintiffs appealed the judgment granting Dr. Guidry's exception of prescription. The court of appeal affirmed. On plaintiffs' application, we granted certiorari to review the correctness of that decision.
Upon the recommendation of a friend, Nancy Rajnowski made an appointment for an examination with Dr. Floyd Guidry, an obstetrician and gynecologist. Her first appointment was on August 30, 1982. After reviewing the results of a blood test, Dr. Guidry confirmed that Mrs. Rajnowski was approximately sixteen weeks pregnant. Dr. Guidry became Mrs. Rajnowski's regular obstetrician and treated her throughout the pregnancy. The doctor's clinical records of Mrs. Rajnowski's first examination indicate no abnormalities except that she was 5'2" and weighed 200 lbs. and had slightly elevated blood pressure.
Mrs. Rajnowski's pregnancy developed normally until December 31, 1982 when a standard office urine test revealed an elevated sugar level of 2+. To rule out other potential causes such as a renal condition, Dr. Guidry ordered further tests including a glucose tolerance test and a post prandial test. On January 3, 1983, the doctor received the results of the lab test which indicated that Mrs. Rajnowski had a fasting blood glucose level of 209 mg.% and 2+ ketones in her urine. Dr. Guidry instructed his nurse to call Mrs. Rajnowski to give her the lab test results but the nurse was unable to reach her because the records contained an incorrect phone number. At the next regularly scheduled examination on January 14, 1983, the office urine test revealed a 2+ sugar level in the urine. Dr. Guidry diagnosed the condition as gestational diabetes, discussed it with Mrs. Rajnowski and placed her on an 1800 calorie per day diabetic diet. He informed her that, if untreated, gestational diabetes could cause the death of the fetus. He also told her that it would be necessary to induce labor early because there was a greater risk of death to the fetus if the pregnancy were allowed to continue for the full term of forty weeks. At this examination, the doctor ordered a second set of lab tests. The lab conducted these tests but invalidated the results because Mrs. Rajnowski had not fasted as required prior to taking the test. Dr. Guidry decided to allow time for the diet to control the diabetic condition and did not order Mrs. Rajnowski to repeat the lab tests.
At the next two regular examinations, the office urine tests showed lower levels of sugar in the urine. On January 21, 1983 the sugar level was 1+ and on January 23, 1983 the sugar level was negative. Dr. Guidry interpreted these results to mean that the diet was working to control the gestational diabetes. He believed there was no need to test for ketones at these examinations because, when the urine sug ar level is 2+ or lower, there is only a trace or a negative level of ketones in the urine. On January 31, 1983, the urine test revealed a 1+ sugar level. Mrs. Rajnow-ski complained of some decreased fetal movement; however, the doctor stated that this was not an uncommon complaint toward the end of pregnancy. Because the sugar level was slightly elevated, fetal movement had decreased and the pregnancy was in the thirty-eighth week, Dr. Gui-dry scheduled induction of labor for the following day, February 1,1983. Although a subsequent urinalysis after the delivery did reveal some ketones, Dr. Guidry explained that this result was consistent with starvation during labor and delivery.
On the morning of February 1, 1983, Mrs. Rajnowski was admitted to St. Patrick's Hospital and induction of labor began. At approximately 12:30 p.m. Dr. Gui-dry decided to perform a caesarean section because the fetal monitor showed some distress, and the labor was not progressing naturally. The doctor discussed these findings with Mrs. Rajnowski and obtained her consent to the procedure. Prior to the procedure, Mrs. Rajnowski had been given epidural anesthesia which eliminates pain but allows the patient to remain alert and to move the lower body. Upon delivery, Dr. Guidry found that the umbilical cord had a true knot and was wrapped around the infant's neck four times. Immediately after delivery, the infant was in a depressed state with no heart rate. The ap-gar score at one minute was 2 of a possible score of 10. The infant responded well to resuscitation which included an external cardiac massage, oxygen and intubation. The apgar score at five minutes was 7, indicating a significant improvement. The infant was male and weighed 6 lbs. and 5 ozs. There was no evidence that the infant had brain damage at delivery or during hospitalization. The infant did not immediately suffer complications normally associated with brain damage such as seizures, renal failure or congestive heart failure. He was initially placed in intensive care and remained hospitalized until February 16, 1983.
The infant developed normally until October 1983 when he had a seizure at eight and one half months of age. Dr. Kim, the infant's pediatrician, believed that the seizure was due to high fever. The seizures continued periodically. In July 1984, Dr. William Bell, a pediatric neurologist, examined the child. He inquired about the prenatal period and delivery as well as other medical history. He found that there were indications of epilepsy and developmental delay, but concluded that the seizures were idiopathic or of unknown origin. In early 1985, Mr. and Mrs. Rajnowski viewed a television program concerning the connection between DPT injections and seizures. They consulted an attorney, Mr. Peter Pulaski, in June or July of 1985. When Mr. Pulaski failed to obtain the medical records of the pregnancy and delivery as he had agreed to do, Mr. Rajnowski obtained them in July or August of 1985. The child was then examined by Dr. Robert Summers, a pediatric neurologist, in July, 1985. Dr. Summers inquired about the complete medical background including pregnancy and delivery. On August 2, 1985, Dr. Summers informed Mr. and Mrs. Rajnowski that the child had brain damage in the right temporal lobe. He stated that the damage could have occurred at any time, including during pregnancy or delivery. A few months later, Mr. Pulaski informed Mr. and Mrs. Rajnowski that they did not have a cause of action based on the DPT injections. They subsequently contacted a second attorney, Mr. Lou Pignatelli, in the summer of 1986. A request for review of their claim was filed with the Commissioner of Insurance under La.R.S. 40:1299.-47(A)(2)(a) on August 1, 1986. Suit was subsequently filed on September 29, 1986.
Plaintiffs contend that their cause of action has not prescribed because Dr. Gui-dry's failure to disclose material information triggered the application of the doctrine of contra non valentem, interrupting the prescriptive period. They argue that Dr. Guidry failed to disclose material infor mation on the condition of Mrs. Rajnowski during pregnancy and that this prevented them from availing themselves of their cause of action. Dr. Guidry contends that plaintiffs' cause of action has prescribed under La.R.S. 9:5628 because suit was filed more than three years after the birth of the child and because his conduct did not rise to the level of concealment, misrepresentation, fraud or ill practices necessary to trigger application of the doctrine of contra non valentem.
The central issue in this case is whether Dr. Guidry's conduct constitutes concealment, misrepresentation, fraud or ill practices that prevented plaintiffs from availing themselves of their cause of action triggering the application of the doctrine of contra non valentem.
The time for filing medical malpractice actions is set forth in La.R.S. 9:5628. The statute provides:
No action for damages for injury or death against any physician, chiropractor, dentist, psychologist, or hospital duly licensed under the laws of this state, whether based upon tort, or breach of contract, or otherwise, arising out of patient care shall be brought unless filed within one year from the date of the alleged act, omission, or neglect, or within one year from the date of discovery of the alleged act, omission, or neglect; however, even as to claims filed within one year from the date of such discovery, in all events such claims shall be filed at the latest within a period of three years from the date of the alleged act, omission, or neglect. (Emphasis added).
Contra non valentem is a judicially created exception to the general rule of prescription and is based on the civilian doctrine of contra non valentem agere nulla currit praescripto. The doctrine applies in four general situations:
(1) where there was some legal cause which prevented the courts or their officers from taking cognizance of or acting on the plaintiff's action;
(2) where there was some condition coupled with a contract or connected with the proceedings which prevented the creditor from suing or acting;
(3) where the debtor himself has done some act effectually to prevent the creditor from availing himself of his cause of action;
(4) where the cause of action is not known or reasonably knowable by the plaintiff, even though his ignorance is not induced by the defendant.
Whitnell v. Menville, 540 So.2d 304, 308 (La.1989).
This court held that the legislature by enacting La.R.S. 9:5628 has in a limited manner legislatively overruled the fourth exception of the judicially created doctrine of contra non valentem as it applies to medical malpractice actions filed more than three years after the date of the act, omission or neglect. Chaney v. State Through Dept. of Health and Human Resources, 432 So.2d 256, 259 (La.1983). See also Whitnell, 540 So.2d at 309. This court has recently addressed the applicability of the third category of contra non valentem, that is, whether the debtor himself has done some act effectually to prevent the creditor from availing himself of his cause of action, to medical malpractice actions. In Gover v. Bridges, 497 So.2d 1364 (La.1986), this court held that the defendant's misstatements did not constitute fraud, concealment, misrepresentation or a breach of a duty to disclose, and did not prevent plaintiffs from learning of the cause of action and filing suit. In Whitnell, 540 So.2d at 310, the court found that defendant's alleged negligent misdiagnosis was not sufficient to trigger application of the doctrine, but remanded to allow amendment of the petition because plaintiffs had raised a colorable argument that defendant breached his duty to disclose material information. The court stated, but did not decide, that a breach of a duty to disclose material information regarding a patient's physical condition might fall within the third category of contra non valentem.
Plaintiffs' expert, Dr. Michael Hughey, evaluated the medical records of the pregnancy and delivery, and concluded that Mrs. Rajnowski had ketoacidosis during the last month of her pregnancy. He based his finding on the lab test results showing 2+ and moderate ketone levels in the urine on January 3 and January 17, 1983, respectively. He stated that ketoaci-dosis could have caused hypoxic brain damage to the fetus by reducing uterine blood flow and diminishing the oxygen content of the fetal blood. He concluded that Dr. Guidry should have hospitalized Mrs. Rajnowski and started insulin treatment at that time. Dr. Guidry maintains that the medical evidence indicated only gestational diabetes and not ketoacidosis. Dr. Gui-dry's experts, Dr. Peter LaFuria and Dr. Elias Chalhub, evaluated the records and concluded that the evidence at delivery gave Dr. Guidry no reason-to doubt his original diagnosis or to believe that the diabetes was out of control during the last month of the pregnancy.'
Dr. Guidry informed Mrs. Rajnow-ski that she had gestational diabetes and that uncontrolled diabetes could lead to the death of the fetus. After Mrs. Rajnowski began following the prescribed diet, office urine tests indicated that her urine sugar level was decreasing gradually. On January 14, 1983, there was 2+ sugar in the urine. On January 21, 1983, there was 1 + sugar in the urine. On January 28, 1983, there was a negative sugar level in the urine. These results indicated that the diet was working to control the gestational diabetes. Dr. Guidry believed there was no need to continue testing for ketones because a 2+ or lower level of sugar in the urine indicates trace or negative levels of ketones in the urine. At delivery, the amniotic fluid was clear, and showed no signs of meconium staining that would usually indicate severe fetal distress during pregnancy or at birth. After clinical examination, the placenta and umbilical cord showed no evidence of any abnormalities that could be expected in uncontrolled diabetes. Further, at birth, the infant showed no signs indicative of a case of severe uncontrolled diabetes or ketoacidosis in the mother. The infant did not have significant congenital abnormalities such as ma-cronomia, an extremely large body. There were no signs of acute asphyxia, renal failure, congestive heart failure or seizures during the newborn period. The infant did have some conditions that would have been found in any child whose mother had gestational diabetes. Based on this evidence, Dr. Guidry did not believe that the gestational diabetes was out of control or had developed into ketoacidosis during pregnancy. Moreover, he thoroughly discussed all of his findings during the pregnancy and after delivery with Mrs. Rajnowski. He informed her of all of the medical evidence that he considered material. Under the circumstances, we conclude that Dr. Guidry's nondisclosure of the test results showing some ketones in the urine did not constitute concealment of material information.
Plaintiffs also contend that Mrs. Rajnowski had hypertension throughout her pregnancy and that Dr. Guidry should have informed her of this condition. Dr. Guidry informed Mrs. Rajnowski that her blood pressure was elevated on several occasions. He attributed the slight elevation in blood pressure to Mrs. Rajnowski's weight. He thought that medication was not warranted because it could have reduced the blood flow to the fetus. Throughout her pregnancy, plaintiff's dias tolic blood pressure was below the borderline of 100. Moreover, there was no evidence of hypertensive changes in the placenta. Because Mrs. Rajnowski's blood pressure was never dangerously elevated and did not vary significantly during the pregnancy, Dr. Guidry did not believe it was necessary to further inform her of this condition. We agree that Dr. Guidry did not withhold any material information regarding this condition.
Moreover, Dr. Guidry did not prevent plaintiffs from learning of or availing themselves of their cause of action. Plaintiffs were aware of sufficient information to incite their inquiry. They became aware that the child had a seizure disorder when seizures began occurring approximately eight and one half months after the birth of the child. Plaintiffs were also aware that the diabetic condition and complications during delivery were potentially very serious and could have caused the fetus' death. Dr. Guidry's conduct did not preclude plaintiffs from acquiring the medical records of the pregnancy and birth. The records were available at all times, yet plaintiffs did not request them until over two years after the birth of the child.
In conclusion, we find that Dr. Guidry discussed all of his material findings with plaintiffs, and did not withhold any material information. Clearly, his conduct did not rise to the level of concealment, misrepresentation, fraud or ill practices necessary to trigger application of the doctrine of contra non valentem. Moreover, Dr. Gui-dry's conduct did not prevent plaintiffs' discovery or timely filing of their suit. Accordingly, plaintiffs' cause of action prescribed under La.R.S. 9:5628 because suit was filed more than three years after the date of the alleged act of negligence and there was no interruption of prescription.
DECREE
For the reasons assigned, the judgment of the court of appeal is affirmed.
DENNIS, J., concurs with reasons.
CALOGERO, C.J., and SHORTESS and LEMMON, JJ., dissent and assign reasons.
. 551 So.2d 806 (La.App. 3d Cir.1989).
. 556 So.2d 1252 (La.1990).
. A ketone is an organic acid which when found in excessive amounts in the body are an indication of uncontrolled diabetes. Black's Medical Dictionary 501 (32nd ed. 1979).
.The actual results of this test indicated a fasting blood glucose level of 263 mg.% and a moderate level of ketones in the urine.
. A DPT injection is a vaccination against diphtheria, pertussis and tetanus.
. Prescription does not run against a party unable to act. Crier v. Whitecloud, 496 So.2d 305, 307 n. 4 (La.1986).
. The parties entered a stipulation in which they agreed to allow the trial court to consider several medical reports written by the parties' experts.
. Ketoacidosis is a condition in which excessive amounts of ketones accumulate in the blood and urine. Symptoms include changes in senso-rium, deep respiration, fruity acetone odor on the breath, nausea and vomiting, abdominal tenderness, extreme thirst and dry mucous membranes, weight loss, and diabetic history in most patients. Treatment of ketoacidosis includes correction of five abnormalities: hyperglycemia, acidosis, low blood volume, hyperos-molality, and potassium loss. Merck Manual, 1073, 1080-81 (15th ed. 1987).