Opinion ID: 1925590
Heading Depth: 1
Heading Rank: 4

Heading: Discovery of Injury.

Text: A. Background. Before beginning our analysis, we think it would be helpful to review the case law about statute of limitations for private-party medical malpractice actions before and after the legislature passed Iowa Code section 614.1(9). In Schnebly v. Baker, this court noted that the general rule in tort cases is that the period of limitations commences when the tort is committed. 217 N.W.2d 708, 721 (Iowa 1974). The court also noted that courts had developed two exceptions, both founded on the unawareness of the plaintiff of his injury or of its cause. Id. The one exception was the discovery rule and the other was the fraudulent concealment doctrine. Id. at 721-22. Finally, the court explained that both exceptions were part of the Iowa law. Id. Several years before Schnebly, this court adopted the discovery rule for negligence actions generally in Chrischilles v. Griswold, 260 Iowa 453, 463, 150 N.W.2d 94, 100 (1967) (plaintiff unaware of defective design until water dripped through ceiling). In Chrischilles, the court noted the general rule is that a cause of action accrues when the aggrieved party has a right to initiate and maintain a suit. 260 Iowa at 461, 150 N.W.2d at 99. A cause of action for negligence does not accrue until there is an injury resulting from the negligence. Id. The statute of limitations does not begin to run until the cause of action accrues. Id. at 461, 150 N.W.2d at 100. In Chrischilles, the court, in adopting the discovery rule as an exception to the statute of limitations, expressed the discovery rule this way: [A] cause of action based on negligence does not accrue until plaintiff has in fact discovered that he has suffered injury or by the exercise of reasonable diligence should have discovered it.... Id. at 463, 150 N.W.2d at 100. By injury, the court meant injury to [the plaintiff's] interest. Id. at 463, 150 N.W.2d at 101; see also 51 Am.Jur.2d Limitations of Actions § 148, at 546 (2000) (The test to determine when a cause of action arises or accrues is when the plaintiff has suffered a legal injury, that is, when he or she has the right to maintain an action....) In applying Iowa Code section 614.1(2)the general statute of limitations in tort cases for injuries to the person  this court in Baines v. Blenderman adopted the discovery rule in a medical malpractice case. 223 N.W.2d 199, 201-02 (Iowa 1974). In Baines, during the course of surgery to repair the plaintiff's herniated disc, the plaintiff lost the vision of his right eye apparently because the blood supply to the eye was cut off for two or more minutes during the operation. The plaintiff discovered four months after the operation that the defendant had negligently caused the injury, and the plaintiff did not file suit until two years and two months after the surgery. Id. at 200, 203. In Baines, the court noted that in Chrischilles, the court had approved the following statement from Johnson v. Caldwell, 371 Mich. 368, 123 N.W.2d 785, 791 (1963), a medical malpractice case: The limitation statute or statutes in malpractice cases do not start to run until the date of discovery, or the date when, by the exercise of reasonable care, plaintiff should have discovered the wrongful act. 223 N.W.2d at 201. Significantly, in Baines, the court rejected the defendant's contention that perception of physical harm equates with imputed knowledge of its origin in malpractice. In response, the court stated: Knowledge of an injury may or may not be sufficient to alert a reasonably diligent person to the basis of his claim, depending on the circumstances of the case. Id. Baines interpreted the discovery rule to mean that the statute of limitations does not begin to run until the injured person knows or can be charged with knowledge of the existence of his cause of action. Id. The court continued: [I]t is not necessary to prove the plaintiff knew the specific negligence of the defendant nor that he knew the details of the evidence by which to prove the cause of action. It is enough that he knew or may be reasonably charged with knowledge of sufficient facts to be aware he had a cause of action more than two years before it was brought. Id. Finally, the court noted that it would be unjust to require a plaintiff to seek a remedy before he knows of his rights. Id. at 202-03. Such a requirement would force a patient to submit to physical examinations by a series of independent physicians after every operation or treatment he received from the physician of his first choice. The unreasonableness of such a result is self-evident. Id. at 203. In 1975one year following Baines  the Iowa legislature amended statutory provisions dealing with medical malpractice. The new legislation was based on a finding that a critical situation exists because of the high cost and impending unavailability of medical malpractice insurance. 1975 Iowa Acts ch. 239, § 1. Within the same chapter of the Iowa Acts, the legislature added a new subsection for the statute of limitations to specifically control medical malpractice cases. Id. § 26 (codified at Iowa Code § 614.1(9) (2001)). That provision provides in part: Actions may be brought within the times herein limited, respectively, after their causes accrue, and not afterwards, except when otherwise specially declared: .... 9. Malpractice. ... [T]hose founded on injuries to the person or wrongful death against any physician ..., arising out of patient care, within two years after the date on which the claimant knew, or through the use of reasonable diligence should have known, or received notice in writing of the existence of, the injury or death for which damages are sought in the action, whichever of the dates occurs first.... Iowa Code § 614.1(9) (emphasis added). Shortly after the legislature passed section 614.1(9), this court had the opportunity to examine the legislature's purpose in enacting the provision. The court concluded legislative history clearly suggested that the legislature passed the provision in direct response to our Baines decision and to restrict the Baines discovery rule. See Schultze v. Landmark Hotel Corp., 463 N.W.2d 47, 50 (Iowa 1990) (citing Koppes v. Pearson, 384 N.W.2d 381, 387 (Iowa 1986) (citing Farnum v. G.D. Searle & Co., 339 N.W.2d 392, 395 (Iowa 1983)); Kohrt v. Yetter, 344 N.W.2d 245, 247 (Iowa 1984)). With this background in mind, we turn to the question whether the discovery rule applies in this case. For reasons that follow, we conclude it does not. B. Analysis. The critical language in section 614.1(9) is injury or death for which damages are sought. Dr. Dawson contends as he did in the district court that the injury for purposes of section 614.1(9) was the removal of Schlote's voice box. Because the Schlotes filed their lawsuit more than two years after the surgery to remove Schlote's voice box, section 614.1(9) bars the suit under this interpretation of the statute. The Schlotes counter as they did in the district court that the injury for purposes of section 614.1(9) was not the removal of the voice box. Rather, the injury was the excessive surgery resulting in the unnecessary removal of the voice box. The Schlotes were not aware of the unnecessary and excessive nature of the surgery until August 1998. This was less than two years before they filed suit. The fighting issue boils down to the meaning of injury in the phrase injury or death for which damages are sought in section 614.1(9). The statute does not define injury. So we look to its ordinary and common meaning. State v. Webb, 648 N.W.2d 72, 82 (Iowa 2002). There are several dictionary meanings for the word injury. One meaning is harm or damage that is done or sustained. Webster's Encyclopedic Unabridged Dictionary 983 (1996). This is the meaning Dr. Dawson gives to the word injury in section 614.1(9). The dictionary also gives what it describes as a legal meaning: any wrong or violation of the rights, property, reputation of another for which legal action to recover damages may be made. Id. This is the meaning the Schlotes implicitly give to the word injury in section 614.1(9). This is also the meaning the Restatement (Second) of Torts gives to the word injury. The Restatement describes injury as the invasion of any legally protected interest of another. Restatement (Second) of Torts § 7(1), at 12 (1965). This meaning is also the meaning Chrischilles gave to the word injury in its definition of the discovery rule. Chrischilles, 260 Iowa at 463, 150 N.W.2d at 101 (We conclude that plaintiff's cause of action did not accrue until he discovered or in the exercise of reasonable diligence should have discovered the injury to his interest ....) (emphasis added). In contrast, the Restatement describes physical harm as the physical impairment of the human body.... Restatement § 7(3). This is the meaning that Dr. Dawson gives to the word injury in section 614.1(9). We think Schultze is strong support for Dr. Dawson's position. The question in Schultze was whether the statute of limitations under section 614.1(9) begins to run on discovery of the death or on discovery of the wrongful act that caused the death. 463 N.W.2d at 48. Similar to the question here, the issue boiled down to the meaning of death in the following italicized language in section 614.1(9): ... [T]hose founded on injuries to the person or wrongful death against any physician ..., arising out of patient care, within two years after the date on which the claimant knew, or through the use of reasonable diligence should have known, or received notice in writing of the existence of, the injury or death for which damages are sought in the action.... Iowa Code § 614.1(9) (emphasis added). The plaintiff argued that the words injury and death in the italicized language must be preceded by the modifiers personal and wrongfully so that the language reads: within two years after the date on which the claimant knew ... of the [personal] injury or [wrongful] death.... Schultze, 463 N.W.2d at 48-49. The plaintiff argued that this construction was necessary to effect the intent of the legislature thereby giving meaning to the discovery rule. Id. at 49. In Schultze, the plaintiff, like the Schlotes here, argued that the plaintiff should be able to use the discovery rule because the plaintiff was not immediately aware of the doctor's wrongful conduct that caused the death. Id. We rejected the plaintiff's argument. We reasoned that the common usage [of] the word `death' refers to the end of life, a time certain. Id. We also said subsection 9 standing alone is intelligible and the meaning is clear. Id. We therefore concluded that the statute of limitations on medical malpractice actions for wrongful death begins to run on the date of discovery of death, and not on date of discovery of the wrongful act that caused the death. Id. at 48. We also said that subsection 9 provides its own modified discovery rule by commencing the two-year limitation period from the date on which [plaintiff] knew, or through the use of reasonable diligence should have known, or received notice ... of, the ... death.... There is no suggestion or hint in this language that the legislature intended that we impose a different commencement date for the limitation period by imposing an additional condition that plaintiff knew the death was wrongful. To further extend the limitation period would be contrary to the plain language of the subsection and the legislature's intent to restrict the length of time for commencing malpractice actions. Additionally, it would create a discovery rule that supersedes a statutorily imposed discovery rule. This is contrary to the legislative intent. Id. at 50. Moreover, we rejected the plaintiff's arguments that the discovery rule should apply to section 614.1(9) because of the `extreme hardship' and `strained and impractical result' it works on survivors. Id. at 51. We did so because such arguments were based on judicial discretion used to implement notions of fairness rather than giving effect to the priorities that the legislature has set forth in an express statutory provision. Id. Given the legislature's use of the conjunction or between the words injury and death in the above italicized language in section 614.1(9), the inescapable conclusion is that the legislature had in mind physical harm when using the word injury rather than the wrongful act that caused the injury. We say this because death is the ultimate injury. As Schultze points out, the legislature did not insert the modifier personal before injury; nor should we under the guise of judicial interpretation. The legislative history we discussed and the policy considerations underlying section 614.1(9) support our conclusion. As mentioned, the legislature passed section 614.1(9) in direct response to Baines and to restrict the Baines discovery rule. Moreover, contrary to the conclusion we reach here, Baines refused to equate physical harm with imputed knowledge of its origin in malpractice. Baines, 223 N.W.2d at 201. In doing so, the court stated: Knowledge of an injury may or may not be sufficient to alert a reasonably diligent person to the basis of his claim.... Id. Contrary to Baines, section 614.1(9) no longer requires that the plaintiff be aware of the defendant's wrongful conduct before the clock starts to run. See Langner v. Simpson, 533 N.W.2d 511, 517 (Iowa 1995) (section 614.1(9) begins to run even though the patient does not know the physician had negligently caused the injury). Nevertheless, the Schlotes would have us use the Baines discovery rule because the excessive and unnecessary surgery is not the injury but the wrongful act. In Luem v. Johnson , the Georgia Court of Appeals interpreted a medical malpractice statute of limitations similar to Iowa Code section 614.1(9). 258 Ga.App. 530, 574 S.E.2d 835, 838 (2002). The Georgia statute provided that an action for medical malpractice shall be brought within two years after the date on which an injury or death arising from a negligent or wrongful act or omission occurred. Id. (emphasis added). The court, reaching the same result as we have reached here, concluded: Georgia's current medical malpractice statute of limitation begins to run upon occurrence or discovery of the injury even where, as here, plaintiff's lack of awareness of the causal relationship between the injury and defendant's breach of duty effectively precludes her from bringing suit at that time. Id. at 839. Here, as Dr. Dawson argues, the injury was the removal of the voice box on May 21, 1996. The statute of limitations began to run on that date because Schlote knew at the time that the surgery would result in removal of his voice box. The Schlotes did not file this lawsuit until February 17, 2000. This was more than two years after the surgery. Therefore the malpractice action is time-barred unless the fraudulent concealment doctrine applies. We recognize that our interpretation of section 614.1(9) eliminates the discovery rule for medical malpractice claims as we have known it. Moreover, the facts here aptly demonstrate that the statute severely restricts the rights of unsuspecting patients who may be injured because of unnecessary and excessive surgery. However, it is up to the legislature and not this court to address this problem. As we have recognized, [Statutes of limitation] are by definition arbitrary, and their operation does not discriminate between the just and the unjust claim, or the voidable and unavoidable delay. They have come into the law not through the judicial process but through legislation. They represent a public policy about the privilege to litigate.... Schulte v. Wageman, 465 N.W.2d 285, 287 (Iowa 1991) (citation omitted). Finally, the conclusion we reach requires us to overrule Lawse v. University of Iowa Hospitals, 434 N.W.2d 895, 898 (Iowa Ct.App.1988) (relying on Baines, the court of appeals concluded injury in section 614.1(9) means discovery of one's cause of action for negligence). That brings us to the fraudulent concealment issue.