Title: Pia Mancuso and Lenny Mancuso v. Spero Neckles, M.D., et als.
Citation: N/A
Docket Number: a-90-98
State: new-jersey
Issuer: new-jersey Supreme Court
Date: February 16, 2000

(This syllabus is not part of the opinion of the Court. It has been prepared by the Office of the Clerk for the convenience of the reader. It has been neither reviewed nor approved by the Supreme Court. Please note that, in the interests of brevity, portions of any opinion may not have been summarized). O'HERN, J., writing for a unanimous Court. This appeal and that in Gallagher v. Burdette-Tomlin Medical Hospital, ____ N.J. ____ (2000), also decided this date, involves the application of the discovery rule to a claim of medical malpractice that would otherwise be barred by the statute of limitations. Pia Mancuso is a breast cancer victim whose relevant mammography history began in 1988. At that time, when Mancuso was thirty seven years old, two routine mammograms were read by Dr. Beinart as showing a benign cyst in her right breast. Subsequently, in 1991, she had another mammogram in anticipation of undergoing a hysterectomy. The films of the two prior mammograms were sent to the radiologist interpreting the 1991 film. In the 1991 film, the radiologist observed and noted ovoid densities in Mancuso's right breast and cautioned the surgeon, Dr. Neckles, to order follow-up studies within four months. No one informed Mancuso of any abnormalities in the mammogram films or of the advice to Dr. Neckles to follow-up. In July 1992, Mancuso had another mammography, which disclosed the onset of cancer. By December 1992, because of the extent of her tumor and its spread, Mancuso endured bone marrow transplant, chemotherapy, and radiation. At around this time, she learned for the first time of the abnormalities shown in the 1991 pre hysterectomy film and of the radiologist's recommendation of a four-month follow-up. Subsequently, Mancuso consulted an attorney regarding Dr. Neckles' failure to follow-up. In June 1994, the attorney received an expert medical report indicating that Neckles committed medical malpractice when he failed to order follow-up studies. Mancuso then filed suit against Dr. Neckles in July 1994 within two years of December 1992, when she learned of the abnormalities in the 1991 films and of the radiologist's recommendation for follow up. In April 1996, Dr. Neckles' medical expert submitted a report expressing the opinion that the 1989 mammogram showed a possible malignancy. Thereafter, in November 1996, Mancuso's attorney retained a new medical expert who reported that a possible malignancy was evident in the 1989 mammographic films and that Dr. Beinart, who interpreted the films, deviated from accepted standards of radiological care. In July 1997, Mancuso filed an amended complaint to include Dr. Beinart as an additional defendant. The trial court dismissed Mancuso's complaint against Dr. Beinart on the basis that the statute of limitations had run. The Appellate Division affirmed the Law Division's ruling, concluding that a reasonable person in Mancuso's position should have been aware that persons (including any of the radiologists who read the mammograms) other than Dr. Neckles could have been responsible for the delayed diagnosis. The Supreme Court granted Mancuso's petition for certification. HELD: Because Mancuso was reasonably unaware that her advanced cancer may have been due in part to the negligence of Dr. Beinart in interpreting her earlier mammography films, she may properly invoke the discovery rule to begin an action against him beyond two years after his alleged malpractice. 1. The essential purpose of the discovery rule is to avoid the harsh results that otherwise would flow from mechanical application of a statute of limitations. Thus, the doctrine postpones the accrual of a cause of action so long as a party reasonably is unaware either that he or she had been injured, or that the injury is due to the fault or neglect of an identifiable individual or entity. (pp. 2-3) 2. Statutes of limitation, which are primarily statutes of repose, are designed to stimulate litigants to pursue their actions diligently. (pp. 3-4) 3. In order to start the statute of limitations running in the context of medical malpractice, more is required than mere speculation or an uninformed guess without some reasonable medical support that there was a causal connection between the condition claimed and the physician's conduct. Thus, the nature of the information available to the injured party becomes relevant. (pp. 8-11) 4. The nature of the information Mancuso possessed before April 1996, when she learned of Dr. Neckles' expert's opinion, did not suggest that the spread of her cancer may have been due to the fault of Dr. Beinart. (pp. 11-14) 5. When a patient has relied on competent expert advice that one or more of her treating physicians did not contribute to the patient's injuries, later assertions to the contrary by a competent expert would then provide the basis for an actionable claim. However, in order to apply the discovery rule, it must be shown that a defendant has not been unfairly prejudiced by the delay. (pp. 14-15) 6. Although Dr. Neckles has died, his testimony is not crucial to this inquiry inasmuch as Mancuso's claim involves the proper interpretation of mammographic films already in existence. Thus, there is no unfair prejudice by the delay in the filing of the complaint against him. (p. 15) Judgment of the Appellate Division is REVERSED and the complaint is REINSTATED and REMANDED to the Law Division. CHIEF JUSTICE PORITZ and JUSTICES GARIBALDI, STEIN, COLEMAN, and VERNIERO join in JUSTICE O'HERN's opinion. JUSTICE LONG did not participate. SUPREME COURT OF NEW JERSEY A- 90 September Term 1998 PIA MANCUSO and LENNY MANCUSO, her husband, Plaintiffs-Appellants, v. SPERO NECKLES, M.D., by PETER J. NECKLES, ADMINISTRATOR OF THE ESTATE OF SPERO NECKLES; KARL G. KLINGES, M.D., DAVID G. BUTLER, M.D., JAMES C. VAN ELSWYK, M.D., SPERO NECKLES, M.D., PROFESSIONAL ASSOCIATION also known as DRS. KLINGES, BUTLER, VAN ELSWYK, NECKLES, P.A.; HERBERT A. GOLDFARB, M.D.; HERBERT A. GOLDFARB M.D., P.A.; MONTCLAIR IMAGING CENTER; STEVEN SIRECI, M.D. and JOHN DOE 6 through 7 (being fictitious names, true names presently unknown), Defendants, and CLIFFORD BEINART, M.D., Defendant-Respondent. Argued November 8, 1999-- Decided February 16, 2000 On certification to the Superior Court, Appellate Division, whose opinion is reported at 316 N.J. Super. 128 (1998). Alfred D. Dimiero argued the cause for appellants (Mella and Dimiero, attorneys). William L. Gold submitted a brief on behalf of amicus curiae, Association of Trial Lawyers-New Jersey (Brown &amp; Gold, attorneys). The opinion of the Court was delivered by O'HERN, J. This appeal and that in Gallagher v. Burdette-Tomlin Medical Hospital, ___ N.J. ___ (2000), also decided today, present difficult exercises in the application of the discovery rule. Each case arises in the context of a claim for medical malpractice. "The history and principles underlying the discovery rule have been examined by us on numerous occasions." Abboud v. Viscomi, 111 N.J. 56, 62 (1988)(citing Vispisiano v. Ashland Chem. Co., 107 N.J. 416, 425-27 (1987)). Suffice it to say that the rule's "essential purpose * * * is to avoid harsh results that otherwise would flow from mechanical application of a statute of limitations." [Vispisiano, supra, 107 N.J.] at 426. Accordingly, the doctrine "postpon[es] the accrual of a cause of action" so long as a party reasonably is unaware either that he [or she] has been injured, or that the injury is due to the fault or neglect of an identifiable individual or entity. Id. at 426-27; accord Lynch v. Rubacky, 85 N.J. 65, 70 (1981); Lopez v. Swyer, [ 62 N.J. 267, 274 (1973)]. Once a person knows or has reason to know of this information, his or her claim has accrued since, at that point, he or she is actually or constructively aware "of that state of facts which may equate in law with a cause of action." Burd v. New Jersey Tel. Co., 76 N.J. 284, 291 (1978). [Abboud v. Viscomi, supra, 111 N.J. at 62-63.] The linchpin of the discovery rule is the unfairness of barring claims of unknowing parties. Statutes of limitations are primarily statutes of repose. They are designed to stimulate litigants to pursue their actions diligently. They penalize dilatoriness and serve as measures of repose. * * * When a plaintiff knows or has reason to know that he [or she] has a cause of action against an identifiable defendant and voluntarily sleeps on his [or her] rights so long as to permit the customary period of limitations to expire, the pertinent considerations of individual justice as well as the broader considerations of repose, coincide to bar his [or her] action. Where, however, the plaintiff does not know or have reason to know that he [or she] has a cause of action against an identifiable defendant until after the normal period of limitations has expired, the considerations of individual justice and the considerations of repose are in conflict and other factors may fairly be brought into play. [Farrell v. Votator Div. of Chemetron Corp., 62 N.J. 111, 115 (1973) (citation omitted).] To reach a just accommodation of these considerations, courts have developed the so-called "discovery" principle adopted first in New Jersey in Fernandi v. Strully, 35 N.J. 434 (1961). July 1997 The patient files an amended complaint to include Dr. Beinart as an added defendant. The trial court dismissed plaintiff's complaint against Dr. Beinart on the basis that the statute of limitations had run. The Appellate Division affirmed the Law Division's ruling, concluding that: A reasonable person in plaintiff's position should have been aware that her expert's opinion was not necessarily the last word on the subject of who might have done her wrong. In 1992, plaintiff knew of her injury, the increase in the cancer caused by a delayed diagnosis, and she knew that it had been possibly caused by the negligence of another. A reasonable person would have appreciated that the universe of possible others included any of the radiologists who had read the mammograms. Dr. Beinart was clearly within that universe. Although plaintiff did not know him by name, she had his reports and mammograms, and she could have as easily identified him by name in 1992 or 1993 as she did in 1997. [Mancuso, supra, 316 N.J. Super. at 134-35.] In reviewing the precedential value of the Mancuso decision, the Appellate Division panel in Gallagher, supra, reasoned otherwise: Mrs. Mancuso was not a physician or a radiologist and had no particular skill or ability to read a mammogram. She also had absolutely no symptoms following the original mammograms. When, several years later, she found that her cancer was advanced, she went to a lawyer in a timely fashion and engaged an expert to review her records, including the 1988 and 1989 mammograms to determine whether her injury was the fault of another. Her expert found malpractice in the 1991 interpretation but none in the 1988 and 1989 readings. Mrs. Mancuso thus had absolutely no reason to doubt the 1988 and 1989 mammograms which were not followed by any symptoms, and which were taken and interpreted by one expert and found by a different expert, hired for litigation purposes, to be beyond reproach. [318 N.J. Super. at 498-99.] [Id. at 434.] This type of case involving medical malpractice requires special focus on the nature of the information possessed by the claimant. Vispisiano explained that cases of complex medical causation are quite unlike cases in which injury and cause are self-evident, as when a record press machine malfunctions and crushes a worker's hand. Ibid. (citing Viviano v. CBS, Inc., 101 N.J. 538 (1986)). In cases of complex medical causation, it is not at all self-evident that the cause of injury was (a) the fault of (b), a third party. Not only is the nature of the injury generally unclear, its very existence is frequently masked. Ibid. In that context of masked injury and complex causation more is required than suspicion _ in the sense of an uninformed guess or of speculation without some reasonable medical support _ of a causal connection between a physical condition and chemical exposure [to start] the running of the statute of limitations . . . . Ibid. In order to start the statute of limitations running in this context of medical malpractice, more is required than mere speculation or an uninformed guess without some reasonable medical support that there was a causal connection between Pia Mancuso's condition and Dr. Beinart's conduct. The Vispisiano Court drew a parallel to Mancuso v. Mancuso, 209 N.J. Super. 51 (App. Div. 1986). In that case, the Appellate Division reasoned that the relationship between trauma and the onset of Parkinson's Disease is a matter of such highly specialized medical knowledge that plaintiff cannot be reasonably chargeable with not having made that connection until she was so advised by the Lahey Clinic neurologist just a month after the running of the statute. Id. at 58. By this, the Vispisiano Court did not mean to suggest that the plaintiff must have an expert report in hand before the statute of limitations will commence to run. See Burd, supra, 75 N.J. at 298-99 (Pashman, J., dissenting). Rather, the Court simply wished to stress the nature of the information available to the injured party. Thus, for example, in Apgar v. Lederle Lab., 123 N.J. 450, 455 (1991), the Court held time-barred the claim of one who knew that her teeth had been discolored and, based on information from several dentists (reasonable medical support), surmised that the medication that she had taken as a child had caused the staining. Applying these principles, we are satisfied that Pia Mancuso was reasonably unaware, until the 1996 deposition, that her injury was possibly due to the fault of Dr. Beinart. The nature of the information that she possessed did not suggest that the spread of her cancer may have been due to the fault of Dr. Beinart. In fact, two sets of medical professionals had confirmed that Dr. Beinart's initial diagnosis of a benign cyst in her right breast was correct. Indeed, Pia Mancuso received years of post-operative care from physicians at the world renowned Memorial Sloan Kettering Cancer Center. Not one of those physicians alerted her to the possibility of fault on behalf of Dr. Beinart. The quality of the requisite state of mind that she possessed appeared blameless. Unlike the plaintiff in Apgar, supra, Pia Mancuso did not suspect, much less have reason to believe, that she may have been injured by the conduct of Dr. Beinart.See footnote 11 [Id. at 274.] In this case, because the claim involves the proper interpretation of mammographic films, we are satisfied that the requisite finding of no prejudice is made. The issue is quite discrete and involves the analysis or reading of x-ray photographs already in existence. Although Dr. Neckles has died, his testimony is not crucial to this inquiry. The judgment of the Appellate Division is reversed. Plaintiff's complaint is reinstated. The matter is remanded to the Law Division. CHIEF JUSTICE PORITZ and JUSTICES GARIBALDI, STEIN, COLEMAN, and VERNIERO join in JUSTICE O'HERN's opinion. JUSTICE LONG did not participate. NO. A-90 PIA MANCUSO and LENNY MANCUSO, her husband, Plaintiffs-Appellants, v. SPERO NECKLES, M.D., by PETER J. NECKLES, ADMINISTRATOR OF THE ESTATE OF SPERO NECKLES; KARL G. KLINGES, M.D., DAVID G. BUTLER, M.D., JAMES C. VAN ELSWYK, M.D., SPERO NECKLES, M.D., PROFESSIONAL ASSOCIATION also known as DRS. KLINGES, BUTLER, VAN ELSWYK, NECKLES, P.A.; HERBERT A. GOLDFARB, M.D.; HERBERT A. GOLDFARB M.D., P.A.; MONTCLAIR IMAGING CENTER; STEVEN SIRECI, M.D. and JOHN DOE 6 through 7 (being fictitious names, true names presently unknown), Defendants, and CLIFFORD BEINART, M.D., Defendant-Respondent. DECIDED February 16, 2000 Chief Justice Poritz We have construed Rule 4:26-4 to permit a plaintiff who institutes a timely action against a fictitious defendant to amend the complaint after the expiration of the statute of limitations to identify the true defendant. In so construing the Rule, we recognized that an amended complaint identifying the defendant by its true name relates back to the time of filing of the original complaint, thereby permitting the plaintiff to maintain an action that, but for the fictitious-party practice, would be time barred. [Viviano v. CBS, Inc., 101 N.J. 538, 548 (1986) (citing Farrell v. Votator Div. of Chemetron Corp., 62 N.J. 111, 120-23 (1973).] The identification of the defendants in this case was always known to plaintiff and therefore, the rule does not come into play.