Opinion ID: 198766
Heading Depth: 2
Heading Rank: 2

Heading: Accrual of Cancer Cause of Action

Text: 23 In conducting our own analysis, we first observe that we have been pointed to no Rhode Island jurisprudence involving latent and delayed cancer resulting from prolonged smoking. We begin with an analysis that leads us to the conclusion that Rhode Island would not follow such a draconian slight injury concept of accrual as was reflected in Joyce. 24 It bears noting that, strictly, this proposition is not disputed. The district court, as we have observed, while mentioning this concept, did not adopt it as a ground for decision. Defendants have similarly refrained from arguing that the earliest respiratory ailments suffered by plaintiff signaled the accrual of her cause of action. Indeed, they distinguish both asbestos and non-asbestos cases cited by plaintiff as involving relatively minor injuries and argue that by 1989 plaintiff knew all she needed to know to bring suit -- that she might have a claim against the Manufacturers for totally disabling respiratory harm. 25 Nevertheless, the authority of the cases tracing accrual of all causes to an initial minor injury seems to survive in some of the argument on appeal. In any event, were such a rule applied to a latent, long-delayed cancer case, it would place, as other courts have observed, a victim in an impossible position. If he did not sue at the earliest onset of breathing difficulty or emphysema, he would risk being barred from pursuing a remedy for a cancer condition discovered much later. If, on the other hand, he brought suit at such an early stage he would not be able to come forward with the proof of sufficient likelihood of damage from cancer to sustain his cause of action. As for the courts, such a rule would unnecessarily thrust them into obviously premature litigation. As then-Judge Ginsburg wrote in Wilson v. Johns-Manville Sales Corp., 684 F.2d 111 (D.C. Cir. 1982): In latent disease cases, this community interest [in balancing the interests of the parties and producing a fair resolution] would be significantly undermined by a judge-made rule that upon manifestation of any harm, the injured party must then, if ever, sue for all harms the same exposure may (or may not) occasion some time in the future. Id. at 119. 26 Moreover, a strict initial-though-slight injury rule would not be consistent with the approach of the Rhode Island Supreme Court in the discovery rule cases that have been cited. For example, in Wilkinson, the court was concerned with the manifest unfairness of barring the enforcement of injury claims brought by a plaintiff who was not, nor could not have known that he was, the victim of tortious conduct because the consequent harm was unknowable within two years of the negligent act. Wilkinson, 243 A.2d at 752. In Lee, the court set forth its rationale for a manifestation of injury rule of accrual saying that a person [should] have a reasonable opportunity to become cognizant of an injury. Lee, 469 F.2d at 361. In Anthony, the court referred to its conscious balancing of policies to prevent the unexpected enforcement of stale claims with the opportunity of a person to have her day in court to vindicate those rights that have been violated but have remained undiscovered or undiscoverable. Anthony, 490 A.2d at 46. 27 We also take note of the willingness of the Supreme Court of Rhode Island to take a realistic approach to the long-established rule against splitting causes of action, not hesitating to carve out situations to which this approach should not apply, where its invocation would work an injustice. For example, in Lemieux v. American Universal Insurance Co., 360 A.2d 540 (R.I. 1976), the court, recognizing the disparity of interests of a subrogated insurer and its insured, permitted each to seek recovery from a third party in separate suits for property damage and personal injury. See id. at 545. 28 We, therefore, are confident that a Rhode Island court would not deem cancer to be so foreseeably related to the very beginning of plaintiff's respiratory difficulties as to identify that as the time of accrual of her cause of action for cancer. Plaintiff argues for setting the time of medical diagnosis of cancer as the time of accrual. While there may be cases where such a time would be appropriate, it is also possible in the case of a long-time addictive smoker that the progression of illnesses, the presence of symptoms indicative of cancer, the nature of materials read, or discussions with doctors, etc., so point to the likelihood of cancer that it is fair to expect a plaintiff to bring suit and where further delays would impose an untoward burden on a defendant. 29 It seems to us, as it did to the district court, that a fair balancing of the legitimate interests of the parties lies in a middle position that would not allow a plaintiff to sleep on her rights but would not, in the interests of repose and evidence preservation, severely jeopardize a plaintiff's opportunity to obtain compensation for contracting cancer. The district court's framing of its decision in terms of the ready foreseeability of cancer from the nature and extent of current disabilities appears to us consistent with the Rhode Island Supreme Court's emphasis in Wilkinson and Lee on the unfairness of barring a plaintiff before he could have become aware of the consequent harm. 30 This approach also reflects a sensitive and sensible balancing of interests. We first note a number of characteristics of cancer that militate against requiring a possible victim, even though an addicted smoker, to make an early decision to commence litigation. The causes of cancer are various, by no means confined to prolonged smoking. Nor is cancer an inevitable result of such smoking. Often its incidence defies foreseeability. It is quite different from afflictions of shortness of breath, emphysema, or other respiratory difficulties. It is of a different magnitude, often involving the possibility of death. Unlike impairments to breathing, cancer does not lend itself to lay identification. It is most dependent upon medical diagnosis. We can understand the apparent absence of case authority for this approach. 31 We pursue our search for an appropriate balance by examining the impact on defendants of a middle approach based on foreseeability. We do not anticipate that this would be an open sesame for stale claims. A plaintiff with some awareness of her susceptibility is not likely to sleep on her rights. Moreover, cancer claims remotely connected in time to earlier illnesses run greater risks of failure of proof, because of the very multiplicity of causes of cancer. A defendant is not without weapons to dismantle a specious claim of ignorance. Particularly, looking to the future, we strongly suspect that it will not be an onerous burden on a defendant to prove that a plaintiff was exposed to enough contemporary information about cancer to have reasonably foreseen its likelihood. We should add that this case went to judgment on a sparse record, containing the plaintiff's deposition and medical records. There was no testimony from other witnesses, including medical experts. No evidence is in the record as to any conversations between plaintiff and doctors or others about suspicion of cancer. 32 In accepting this approach as that which would comport with Rhode Island law, we realize that it points in the direction of fact-intensive analysis. By the same token this introduces unavoidable uncertainty into prediction, litigation, and the attainment of repose. We have, therefore, probed on our own the possibility of linking the time of accrual of a cause of action for cancer to some objectively identifiable stage in the progression of the illness. For example, one might say that once the condition of an addictive smoker has regressed to the stage when she is substantially and permanently disabled, she should be held to know enough to bring suit for present and any subsequent illnesses attributable to her smoking. 33 On close examination, this approach reveals numerous flaws of its own. We first observe that even this approach does not avoid a case by case inquiry into whether the threshold stage of seriousness has been reached. We then realize that the same problem of anticipatory litigation presents itself: a plaintiff, however reluctant to engage in a premature lawsuit, is faced with a sue or lose dilemma before having reliable knowledge of her likelihood of contracting cancer. Paradoxically, instead of serving the truth-enhancing, evidence-preserving function of statutes of limitation, this approach forces resolution before the development of relevant reliable medical or scientific evidence. 34 Even were such a plaintiff able to prove by a sufficient quantum of evidence the likelihood of incurring cancer, her damages would be subject to substantial discounting based upon a range of contingencies regarding the probability of her contracting the disease. The plaintiff would also be subjected to several other burdens. She would be under pressure -- with the consequent expense -- to search for experts to maximize the seriousness of her prognosis, as well as pressure to delay the progress of her suit to take advantage of subsequent deterioration. Such a series of disadvantages jeopardizes the societal interest in affording fair compensation to victims. To the extent that a sue or lose rule based on an arbitrarily defined stage results in a shielding of a tortfeasor, the community interest in deterrence is also compromised.
35 While we are satisfied that the test both we and the district court have articulated reflects a fair balancing of interests, the district court went further, holding that the record was bereft of any genuine issue of material fact and granted summary judgment for defendants. 36 We acknowledge that there may well be some cases in which one could say that the reasonable foreseeability of cancer was not a genuinely disputed fact at a period antedating the limitations period. Generally, however, we suspect that the issue is heavily fact dependent. In this case, on this record, we cannot say that the known conditions affecting plaintiff in 1989 so pointed to a likely development of cancer that she should have brought suit. We rehearse our findings from our scrutiny of the record. 37 We begin by noting that the court, as we have observed, concluded that by 1989 plaintiff had become totally disabled from asthma, emphysema, and COPD, all derived from smoking. Defendants repeatedly assert that by 1989 plaintiff was suffering from totally disabling smoking-related respiratory disease. As we shall explain, these statements considerably overstate the record. 38 The medical record for 1988 and 1989 is replete with doctors' examinations, tests, operations, and evaluations. In April 1988, a myelogram was performed as well as CT scanning by Dr. Birkenfeld, revealing severe spinal stenosis or narrowing of the space in two lower back vertebrae which allowed spinal nerve passage. Numbness and pain in both legs, hindering plaintiff's walking, and bringing her almost [to] the verge of incapacity, had been progressive over the prior three years. 39 In May 1988, after being admitted to Carney Hospital and having a physical examination in which her lungs were found clear to auscultation, plaintiff underwent an operation on her spine -- a lumbar laminectomy, a procedure to remove part of a blockage in the vertebrae. Significantly, before the operation, because of her COPD, plaintiff was given a chest x-ray for pulmonary clearance by Dr. Kogianes, which showed only evidence of COPD and mild artery-associated (atherosclerotic) and/or hypertensive heart disease. After the operation, and temporary progress, plaintiff complained again of back and leg pain, but was sent home under conservative treatment. She was administered a postoperative chest x-ray, which was basically within normal limits. 40 Almost a year later, plaintiff filed a claim for Social Security disability benefits with the State of Rhode Island Department of Human Services. In support of the claim, plaintiff's physician, Dr. Gilman, reported on an examination he had conducted in January 1989. He reported that plaintiff suffered from the following conditions: overweight; [l]ungs revealed a few babesia crackles [babesia being parasites from ticks, destructive of red blood cells]; COPD; high cholesterol; numbness in hands and feet; and pulmonary functions registering from 13 percent to 22 percent under predicted. His diagnosis listed COPD in a continued smoker, hyperlipidemia (excess fat in the blood), a history of spinal stenosis surgery, and neurological symptoms. 41 In July 1989, plaintiff's disability claim was denied and Dr. Gilman was asked to send a supplementary report in connection with her request for reconsideration. He was advised by a lawyer representing her before the Board of Appeals that plaintiff had indicated to him that she is unable to stand, sit or lay in any one position for more than a short period of time, and that she has severe back problems and other related problems and that she is not able to do any sort of gainful activity. 42 On July 31, 1989, Dr. Gilman reported that plaintiff had recently complained of a sore throat, coughing, and yellow sputum. She was found to have pharyngitis, or inflamation of the pharynx, and was treated with antibiotics. She had been scheduled for a second laminectomy but an electrocardiogram showed more T-wave inversions than previously observed, and pulmonary function tests showed a moderate decrease in flows and volumes. Plaintiff took a treadmill test and, at a mild work load, had no abnormalities of concern. She was advised to decrease her smoking and discontinue it because of her COPD. Dr. Gilman's impression listed COPD, continued smoker, hyperlipidemia with high cholesterol, EKG changes, and a history of prolonged back pain. 43 From this record, which summarizes all of the medical history, we discern the following. Both in 1988 and 1989 plaintiff was suffering from a number of afflictions. A substantial portion of her ailments were not obviously related to smoking. Plaintiff was overweight, with excess cholesterol and fat in the blood, and particularly suffered pain and numbness in her hands, feet, and lower back, all of which played a significant role in her health problems. As she is quoted by her lawyer, her inability to pursue gainful employment was linked in a major way to these latter problems. Finally, the fact is that plaintiff's disability claim was disallowed. 44 We therefore cannot say that this record justifies characterizing plaintiff's condition in 1989 as one of total disability from respiratory ailments attributable to smoking. More importantly, we do not think that, as a matter of law, on this record, plaintiff's condition in 1989 so clearly pointed to the onset of cancer such that a lay person could foresee it as likely. Not until the x-ray in November 1993, taken just prior to a planned surgery, was plaintiff's lung cancer revealed. The record does not show that this followed a series of conversations with friends or doctors about the possibility of cancer or of particular books, articles, or media presentations arousing concern. Nor does cancer appear to be linked, as a matter of law, to her prior illnesses. To the contrary, plaintiff was very much in the hands of several doctors, being routinely examined, tested, and evaluated. During the five years prior to her diagnosis her condition was stable. Most critically, she had the assurance given by the two chest x-rays which revealed no hint of cancer. Although we do not pretend to be expert evaluators of medical evidence, no one has suggested that these x-rays should not indicate the absence of cancer. At no time was the possibility of cancer touched upon. On this state of facts, we cannot say as a matter of law that plaintiff in 1988 knew all she needed to know and should have filed suit to recover damages for lung cancer. In fact, had she attempted to recover for the likely contraction of cancer at that time, with recent x-rays showing her lungs to be tumor-free, her chance of success would have been greatly diminished. 45 This record in our view contains sufficient evidence to defeat summary judgment. While plaintiff has the burden to show that her suit was timely, see Kelly v. Marcantario, 187 F.3d 192, 198 (lst Cir. 1999) (stating that plaintiff has burden to show that his claim was filed within statute of limitations due to tolling), defendants, as the movants for summary judgment, have the burden of first establishing that there is no genuine dispute as to any material fact necessary to decision, see Cadle Co. v. Hayes, 116 F.3d 957, 960 (lst Cir. 1997). 46 We conclude that at this juncture there is at least a genuine issue of material fact as to whether plaintiff's condition immediately before the commencement of the limitations period was such as to require a person acting with reasonable diligence to institute suit seeking damages attributable to cancer.