Opinion ID: 852412
Heading Depth: 3
Heading Rank: 3

Heading: Reasonable Diligence in the Face of an Occurrence-Based Statute

Text: In many malpractice cases the injury by its nature is known to the patient and suggests that there may have been malpractice. If so, even under an accrual or discovery-based limitations period reasonable diligence requires pursuing the facts to determine whether there is a claim. See 26 Am.Jur. Proof of Facts 3d Discovery Date 185 § 6, at 196 (1994). Under an occurrence-based statute, however, the critical issue is what reasonable diligence requires, not when the claim accrues or is discovered. Because the Medical Malpractice Act provides an occurrence-based limitations period, reasonable diligence requires more than inaction by a patient who, before the statute has expired, does or should know of both the injury or disease and the treatment that either caused or failed to identify or improve it, even if there is no reason to suspect malpractice. As a matter of law, the statute requires such a plaintiff to inquire into the possibility of a claim within the remaining limitations period, and to institute a claim within that period or forego it. Thus, in Brinkman v. Bueter, 879 N.E.2d 549, 550-51 (Ind.2008), Mrs. Brinkman's first physician noticed all three signs of preeclampsia during a pregnancy check-up, but ruled it out three days later. Shortly after giving birth, Mrs. Brinkman was diagnosed with eclampsia. Id. at 551. A few months later, a second doctor told the Brinkmans that Mrs. Brinkman's preeclampsia had been unusual because she had not exhibited any symptoms until after the birth. Id. The Brinkmans filed their complaint against both doctors nearly five years later, after a third doctor told them that Mrs. Brinkman's symptoms of preeclampsia had not been properly treated. Id. at 552. Although no professional had explicitly advised them of possible improper treatment in the intervening five years, a unanimous Court held that the Brinkmans' claim was untimely. The eclampsia brought to light the potential of the preeclampsia and nothing prevented the Brinkmans from bringing a claim about faulty diagnosis or treatment within the two-year statutory period. Id. at 555. After the diagnosis of eclampsia, the Brinkmans were obligated in exercise of reasonable diligence to learn of the earlier substandard care. Similarly, if the patient cannot with reasonable diligence learn of the injury before the statute has expired, the date on which the patient learns of the injury and the prior treatment starts the limitations period, even if there is no basis to allege malpractice at that point. Thus, in Martin, the limitations period started when breast cancer was identified, because the patient was in a position to uncover the failure to identify it in an earlier mammogram, even if the patient at that point had no indication whether the earlier mammogram suggested her cancer. 711 N.E.2d 1273. Justice Dickson urges deference to Herron's severely restricted condition. This has appeal, but we are not developing the common law in this area. We are exploring the extent to which the Open Courts Clause of Article I, Section 12 of the Indiana Constitution requires constraining the legislative directive that all claims for medical malpractice are barred after two years from the occurrence giving rise to the claim. We therefore may invalidate the statutory directive only to the extent necessary to guarantee access to the courts. Neither inconvenience nor difficulty in proceeding is enough, if reasonable diligence would lead to discovery of the facts giving rise to the claim.