Opinion ID: 1535513
Heading Depth: 1
Heading Rank: 7

Heading: delaware statute of limitations/continuous negligent treatment

Text: The construction of a statute of limitations is not the creation of an exception to it in violation of the legislative function. It is the well recognized duty of a court to construe statutes of limitation so as to establish just and reasonable guidelines for different classes of cases in light of the general policy of repose. Layton v. Allen, supra. at 799. In Delaware, 18 Del.C. § 6856 provides a two-year statute of limitations for injuries discoverable withint two years of the injury and a three-year statute of limitations for inherently unknowable injuries. The applicability of the two or three-year time period clearly depends upon when the patient knows or in the exercise of reasonable diligence could have discovered the existence of a cause of action for continuing negligent medical treatment. Cf. 18 Del.C. § 6856(1). In construing the facts and applying the law in any case, the initial focus must be on the Complaint. In Delaware, allegations of negligence must be pled with particularity and should be examined separately for statute of limitations purposes. Cf. Dunn v. St. Francis Hospital, Inc., supra ., Sanchez v. Abdel-Misih, supra., Klosowski v. Godwin, supra., Williams v. Elias, 140 Neb. 656, 1 N.W.2d 121 (1941), and Superior Court Civil Rule 9(b). The burden of at least alleging with particularity a course of continuing negligent medical treatment during a finite period must rest with the plaintiff. To rule otherwise would force each defendant, claiming that the statutory period had run, to demonstrate no involvement in any after-treatment of the plaintiff which might be considered a cause of the plaintiff's injuries. Sanchez v. Gilberto, supra. However, the bare allegation by a plaintiff that there has been continuous negligent medical treatment is not enough, in and of itself, to successfully defeat a defendant's Motion for Summary Judgment based upon the statute of limitations. The facts alleged by a plaintiff in support of a cause of action for continuous negligent medical treatment must be examined to see if the negligent treatment, as alleged, can be segmented or is, in fact, so inexorably intertwined that there is but one continuing wrong. See Streitz v. LeRoy, supra. and Klosowski v. Godwin, supra. If the allegation in a Complaint for continuing negligent medical treatment during a finite period is supported by the facts in the record, the statute of limitations runs from the date of the last act in the negligent continuum. Oakes v. Gilday, Del.Super. 351 A.2d 85 (1976); see also Rankin v. Olmedo, Del.Super., C.A. No. 77C-AU-10, Taylor, J. (August 21, 1979). A more difficult question is raised by a situation, like the present case, where the patient knows or in the exercise of reasonable diligence could have discovered that a cause of action exists for continuing negligent medical treatment and thereafter permits the physician to treat him anyway. As we observed, persuasive arguments have been made that it is only fair to give a physician an opportunity to take corrective action. [11] However, the Delaware legislature has clearly and unequivocally decided to limit the right to bring a medical malpractice action to a maximum of three years. The force of the Delaware legislature's intent is particularly manifest when one realizes that even for a completely unknown personal injury, the statute of limitations expires three years after that unknown injury, independent of a plaintiff's ability to have ever ascertained the existence of a cause of action within that three year period. [12] In Dunn, we held that the date upon which such injury occurred for the purpose of construing § 6856, was the date of the alleged wrongful act or admission, in determining whether the two-year or the three-year statute of limitations applied. Today we hold, that when the cause of action is for continuous negligent medical treatment, the date upon which such injury occurred is the last act in the negligent medical continuum. Therefore, if a plaintiff has a cause of action for continuous negligent medical treatment and that fact becomes known within two years of an act in the alleged negligent continuum, the statute of limitations begins to run for two years from the last act in the negligent continuum prior to the point in time when the plaintiff has actual knowledge of the negligent course of treatment or in the exercise of reasonable diligence could have discovered the negligent course of treatment. To hold otherwise, would permit the patient that has or should have knowledge of a negligent course of medical treatment to extend the statute of limitations by extending the period of treatment after the negligent course of treatment was or should have been known. [13] We are aware that such a rule limits the health care provider's ability to take corrective action but find that it was the clear intent of the Delaware legislature to have a two-year statute of limitations for known or discoverable wrongs. The patient who continues to be treated by a health care provider after notice (actual or discoverable) that a prior course of medical treatment was negligent, does so at a double peril. First, the patient may not be cured and second, the statute of limitations is running. In effect, with a patient's permission, a health care provider can have two years to undertake corrective measures. However, when a patient has notice of a cause of action for continuing negligent medical treatment and permits the health care provider to continue treatment thereafter, the patient only has two years to commence a legal action or have it barred. This holding is consistent with and supported by our decision in Reyes v. Kent General Hospital, Inc., supra . to the effect that when an inherently unknowable injury becomes known to a plaintiff within the two year period from the alleged date of injury, the plaintiff does not get the additional one year extension provided for in 18 Del.C. § 6856(1) but must file an action within two years. Reyes v. Kent General Hospital, Inc., supra. at 1145. When a plaintiff has a cause of action for continuous negligent medical treatment, it is also entirely possible that like any other cause of action, its viability may be unknown. If a plaintiff has a cause of action for continuous negligent medical treatment and it was unknown to and could not in the exercise of reasonable diligence have been discovered by the injured person, such action must be brought prior to the expiration of three years from the date upon which the last act in the alleged continuum of medical negligence occurred. As we held in Dunn, the limited extension of the statute of limitation period in medical malpractice actions from two years to three years is, in our judgment, intended to give consideration to the problem of an injury which is not physically ascertainable. Dunn, supra. at 79. However, if, in fact, an injury is ascertainable (physically or otherwise) within two years, the three-year statute of limitations is inapplicable. We are cognizant of the fact that when an allegation is made that a course of medical treatment was negligent, it will be difficult to ascertain whether the negligent course of conduct was unknown to and could not in the exercise of reasonable diligence have been discovered by the injured person. In determining whether a patient had knowledge of a negligent course of medical treatment which would commence the running of the two year statute, this Court adopts an objective test, i.e. the reasonably prudent person. However, we also hold that there shall be a presumption that a patient who actually consults with an independent health care provider about the same condition which is subsequently the subject matter of an alleged negligent medical continuum knew or in the exercise of reasonable diligence could have known about the prior negligent course of conduct on date of the consultation with the independent health care provider. [14] If a patient receives independent medical advice from a skilled health care provider in the form of a second opinion or consultation, that patient has a duty of inquiry not only about his condition but about his prior course of medical treatment. In summary we hold: (1) a viable cause of action exists for the ongoing tort known as continuous negligent medical treatment, (2) a continuous course of negligent medical treatment during a finite period must be alleged in a Complaint with particularity, (3) the facts in the record must establish that the treatment was inexorably related so as to constitute one continuing wrong. Absent such an unbroken interrelated chain of events, the applicable statute of limitations will apply to each alleged wrong and not to the course of treatment as a whole, (4) if a continuous course of negligent medical treatment has been alleged and is supported by the facts in the record, the statute of limitations runs for two years from the date of last act in the negligent continuum prior to actual knowledge or the point when a reasonably prudent person, in the exercise of reasonable diligence, could have discovered a prior continuous course of negligent medical treatment, (5) there is a presumption that a patient who actually consults with an independent health care provider about the same condition which is subsequently the subject matter of an alleged negligent medical continuum knew or in the exercise of reasonable diligence could have known about the prior negligent course of conduct on the date of the consultation with the independent health care provider. In such a situation, the statute of limitations begins to run for two years from the last act in the negligent continuum prior to the point in time when the plaintiff consulted with the independent health care provider, and (6) if the course of negligent medical treatment was not known and could not have been discovered in the exercise of reasonable diligence, the statute of limitations runs for three years from the last treatment in the negligent continuum. In the latter situation, the Complaint must allege and the facts in the record must support the assertion that the continuing negligent medical treatment was unknown and could not in the exercise of reasonable diligence have been discovered.