Title: Bowlin Horn v. Citizens Hosp.
Citation: 425 So. 2d 1065
Docket Number: N/A
State: Alabama
Issuer: Alabama Supreme Court
Date: December 30, 1982

425 So. 2d 1065 (1982)
Melinda J. BOWLIN HORN
v.
CITIZENS HOSPITAL, et al.
81-581.

Supreme Court of Alabama.
December 30, 1982.
Rehearing Denied January 21, 1983.
*1066 Stephen D. Heninger of Hare, Wynn, Newell &amp; Newton, Birmingham, for appellant.
R. Blake Lazenby and B. Clark Carpenter, Jr. of Dixon, Wooten, Boyett, Thornton, Carpenter &amp; O'Brien, Talladega, for appellee Citizens Hosp.
W. Michael Atchison and Carol A. Smith of Starnes &amp; Atchison, Birmingham, for appellee Dr. E.H. Roberts.
MADDOX, Justice.
Plaintiff below appeals the granting of summary judgment for the defendants by the trial court on the ground the recovery was barred by the four-year statute of limitations of the Medical Liability Act. The dispositive issue here is whether fraudulent concealment tolls the operation of the Medical Liability Act thereby permitting an action otherwise permitted by the statute to be brought more than four years after the alleged act of malpractice.
Melinda Bowlin Horn, appellant, was at the time of her appendectomy on April 21, 1971, an unmarried 13-year-old. Her physician, Dr. E.H. Roberts, allowed a piece of a sweged needle that broke off during the operation to remain embedded in the thick wall of the girl's abdomen. The "Report of Operation" describes the incident as follows: "In closing the initial oblique muscle, closing loosely to the internal oblique, a tiny bit of the sweged needle was lost in it and rather than losing time for this particular incident, the operation was continued...." Although Dr. Roberts's "Progress Notes" as well as the "Report of Operation" indicated that the broken portion of the needle was left in the incision and that the mother and father had been informed of its presence, the appellant and her parents maintain that they were never informed about the needle, but instead were told that the operation was successful. Dr. Roberts stated in the interrogatories that he did not recall whether he had in fact informed the parents about the broken needle, because the operation had taken place more than nine years before.
*1067 About a year following surgery, the appellant began experiencing abdominal pains. She went to two different physicians on separate occasions for treatment. One physician diagnosed the persistent abdominal pain to be caused by nervousness, while the other physician informed her that the pain was caused by an ulcer. Appellant never informed Dr. Roberts of her persistent abdominal pain and in fact was never again treated by him after her discharge from the hospital following the appendectomy.
In February 1979, the appellant sought treatment from physicians in Birmingham. X-rays revealed the presence of the needle remnant at the site of the appendectomy. On March 9, 1979, a short time following surgery to remove the needle remnant, appellant filed a medical malpractice suit against Citizens Hospital and Dr. Roberts in the Circuit Court of Talladega County. The trial court granted the appellee's motions for summary judgment on March 17, 1982, on the ground that the appellant's claim for recovery was barred by the applicable statute of limitations for malpractice found in Code 1975, § 6-5-482. From this order, appellant appeals.
This Court has not previously addressed the issue of fraudulent concealment as it applies to the Medical Liability Act. See Code 1975, §§ 6-5-480 through 6-5-488. There is no dispute by any of the parties that the action made the basis of this appeal is governed by the Medical Liability Act. This act contains its own limitations as to the time for the commencement of an action. Section 6-5-482(a) of the act reads:
In Street v. City of Anniston, 381 So. 2d 26 (Ala.1980), we remarked with specific reference to this section that:
381 So. 2d  at 31. See also Ramey v. Guyton, 394 So. 2d 2 (Ala.1980).
The Court discussed the origin of the principle of fraudulent concealment in Porter v. Smith, 65 Ala. 169 (1880).
65 Ala. at 172. Section 6-2-3, as appellant suggests, is the embodiment of this equitable notion and it reads:
Appellant notes that Garrett v. Raytheon Co., Inc., 368 So. 2d 516, 521 (Ala.1979), is a reaffirmation by this Court that "fraudulent concealment by a defendant tolls the running of the statute until the tort injury is discovered or could have been discovered by due diligence." Additionally, the appellant maintains that the facts of this case present a classic illustration of a confidential relationship and that where this sort of confidential relationship exists, as between a physician and the patient, the law imposes a strong duty on the physician to disclose facts of medical significance to the patient. Appellant cites the following cases as representing this obligation to disclose where confidential relations exist, Jefferson County Truck Growers Ass'n v. Tanner, 341 So. 2d 485 (Ala.1977); Tonsmeire v. Tonsmeire, 285 Ala. 454, 233 So. 2d 465 (1970); Metropolitan Life Ins. Co. v. James, 238 Ala. 337, 191 So. 352 (1939); Brasher v. First National Bank of Birmingham, 232 Ala. 340, 168 So. 42 (1936). Section 6-5-102 is likewise cited by appellant as imposing an obligation to disclose in this case. This section reads: "[S]uppression of a material fact which the party is under an obligation to communicate constitutes fraud. The obligation to communicate may arise from the confidential relations of the parties or from the particular circumstances of the case." See Harrell v. Dodson, 398 So. 2d 272, 276 (Ala.1981). Consequently, the appellant urges this Court to incorporate the principle of fraudulent concealment into the effects of § 6-5-482 by engrafting § 6-2-3 or § 6-5-102.
Some courts in other jurisdictions appear to have adopted the view that if a surgeon or other medical practitioner obtains actual knowledge that he has negligently left a foreign object in the body of a patient then the practitioner has a duty to disclose the object's presence to the patient. These courts apparently treat the failure of the practitioner to disclose such a condition as a fraudulent concealment which tolls the limitations period until the patient discovers, or, by the use of reasonable diligence, should have discovered, the presence of the object. Annot., 70 A.L.R.3d 7 (1976).
The legislature first enacted a medical malpractice statute of limitations in 1953. Act of Sept. 17, 1953, No. 766, 1953 Ala.Acts 1027 (codified at Ala.Code Tit. 7 § 25(1) (1940)). Act No. 766 provided:
This act was the percursor to the statute of limitations provision enacted in the Medical Liability Act by the legislature in 1975. Act of Sept. 23, 1975, No. 513, § 4, 1975 Ala.Acts 1149, 1150 (codified at Ala.Code § 6-5-482 (1975)).
Prior to the enactment of Act No. 766, the issue of fraudulent concealment was raised in the case of Hudson v. Moore, 239 Ala. 130, 194 So. 147 (1940). The physician was sued by the plaintiff in the Hudson case for leaving a gauze sponge in the plaintiff's body. The operation occurred in 1923 and the suit was brought in 1938. The sole inquiry by the Court in Hudson was whether the facts as set out by the plaintiff prevented the running of the statute until the discovery of the cause of action which was alleged to have been within 12 months before the suit was brought. In Hudson this Court noted:
239 Ala. at 132-133, 194 So.  at 148-149. The trial court, in Hudson sustained the defendant's demurrers and this Court affirmed on the ground that the plaintiff failed to aver the defendant-physician knew he left the sponge in the operation wound. Section 8966, Code 1940, is the forerunner to § 6-2-3, which the appellant urges the Court to apply to the facts in this case.
Although this Court has not directly addressed the principle of fraudulent concealment as it applies to the Medical Liability Act, it was superficially raised in Miller v. *1070 Mobile County Board of Health, 409 So. 2d 420 (Ala.1981). In Miller, the plaintiff alleged fraudulent concealment by the manufacturer of possible side effects and dangers of an intra-uterine device. With regard to that allegation, this Court observed:
409 So. 2d  at 422. This statement by the Court as to the possible extension under § 6-2-3 of the four-year statute of limitations of the Medical Liability Act is merely illustrative, and is not indicative of this Court's predisposition in cases involving alleged fraudulent concealment.
We turn now to the construction of § 6-5-482 and whether fraudulent concealment tolls the statute of limitations in medical malpractice suits, thereby making § 6-2-3 the appropriate limitations period, or whether § 6-5-482 creates an absolute bar to all medical malpractice claims which are brought more than four years after the cause of action accrues.
The construction of subsection (b) of § 6-5-482 is determinative of the outcome of this case. Section 6-5-482(b) reads:
The touchstone of legislative construction is to ascertain and effectuate the intent of the legislature as expressed in the statute. See, e.g., Darks Dairy, Inc. v. Alabama Dairy Commission, 367 So. 2d 1378, 1380 (Ala.1979). Moreover, in determining legislative intent, courts may look to the history of the statute and the purpose sought to be accomplished. State v. T.R. Miller Mill Co., 272 Ala. 135, 139, 130 So. 2d 185, 188 (1961). The forerunner of § 6-5-482(b), § 2 of Act No. 766, provided that actions for medical malpractice were "subject to all existing provisions of law relating to the computation of statutory periods of limitation for the commencement of actions; namely Title 7, Sections 18, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 40, 42, 43, 44, 47, 48 of the Code of 1940." When the Medical Malpractice Act was enacted in 1975, the legislature specifically added the proviso stating "... that notwithstanding any provisions of such sections, no action shall be commenced more than four years after the act, omission or failure complained of...." (Emphasis added.) The appropriate office of a proviso is to restrain or modify the enacting clause, or preceding matter, and should be so confined, unless it is apparent it should apply to some other matter. Touart v. American Cyanamid Co., 250 Ala. 551, 555, 35 So. 2d 484, 486 (1948). While it is likely that fraudulent concealment would have tolled the operation of the statute of limitations under the terms of Act No. 766, thus making the one-year discovery rule the applicable period in which to commence an action (Title 7, § 42 being the predecessor to § 6-2-3), we construe § 6-5-482(b) and the proviso therein as barring recovery for all medical malpractice actions commenced more than four years after the wrongful act or omission producing the injury.
*1071 In shortening the statute of limitations and barring all medical malpractice actions after four years, the legislature, as did other state legislatures, responded to a nationwide medical malpractice crisis caused by proliferating malpractice claims and sizeable malpractice verdicts. The policy considerations of the Medical Liability Act are expressed in the legislation itself. Section 2 of Act No. 513 reads:
1975 Ala.Acts 1149.
The prescription of a reasonable date and time for bringing a particular cause of action is within the inherent power of the legislature. The Court has held:
Plant v. R.L. Reid, 294 Ala. 155, 160, 313 So. 2d 518, 522 (1975). See also Sellers v. Edwards, 289 Ala. 2, 265 So. 2d 438 (1972).
In view of the policy expressed by the legislature as set out in the Medical Liability Act, and in view of the fact that the reasonableness of the period of time allowed a party to bring a suit is primarily a legislative matter, we determine that the four-year limitations period set out in the act is reasonable.
Furthermore, our research indicates that each of our bordering and several of our neighboring states have enacted statutes which control the commencement of malpractice actions.[1] This research shows that of these eight states, all but two, Kentucky and Mississippi, have special provisions for either fraudulent concealment or foreign objects left in a patient's body or a combination of both. The legislature, as it has the authority to do, could have determined that the four-year limitations period was reasonable because it believed an injury sustained by a patient caused by an allegedly negligent act of a physician, irrespective of fraudulent concealment, would generally *1072 become manifest within four years. Indeed, the facts of this case suggest that despite the two misdiagnoses by the two physicians as to the cause of appellant's pain, the needle remnant's presence was nevertheless manifest within the four-year period. Hence, we conclude that had the legislature intended fraudulent concealment or the act of leaving foreign objects in a patient's body to lengthen the period of commencing medical malpractice actions, the legislature could have included a specific provision in the Medical Liability Act to accomplish that purpose.
As for appellant's final contention that the Medical Liability Act is unconstitutional as an arbitrary classification, we note:
Sellers v. Edwards, 289 Ala. 2, 6, 265 So. 2d 438, 440 (1972).
Appellant is likewise directed to our holding in Reese v. Rankin Fite Memorial Hospital, 403 So. 2d 158 (Ala.1981), from which we take the following quotation:
246 Ala. at 9-10, 18 So. 2d 810.
403 So. 2d  at 161-162.
Therefore, summary judgment was properly granted by the trial court as to both appellants on the ground that this action is barred by the four-year provision of § 6-5-482.
AFFIRMED.
TORBERT, C.J., and JONES, SHORES and BEATTY, JJ., concur.
[1]  Arkansas, See Ark.Stat.Ann. § 34-2616 (1981 Supp.);

Florida, See, West's F.S.A. § 95.11(4)(b) (1982);
Georgia, See, Ga.Code 9-3-71 and 9-3-72 (1981);
Kentucky, See Ky.Rev.Stat. § 413.140(2) (1982 Supp.);
Mississippi, See Miss.Code Ann. § 15-1-36 (1982 Supp.);
North Carolina, See N.C.Gen.Stat. § 1-15(c) (1981 Supp.);
South Carolina, See S.C.Code Ann. § 15-3-545 (Law.Coop.1981 Supp.);
Tennessee, See Tenn.Code Ann. § 29-26-116 (1955).