Opinion ID: 1864440
Heading Depth: 1
Heading Rank: 2

Heading: continuous care

Text: Because Altenburg was the anesthesiologist for both of Froysland's surgeries, heart and arm, Froysland argued that the statute of limitations was tolled by continuing care until after the second surgery. Altenburg and Fargo Clinic responded that the continuous treatment rule has not yet been adopted in North Dakota. They submitted that it is unnecessary to adopt the continuous treatment rule in North Dakota because we already apply a generous discovery rule, as recognized in Anderson v. Shook, supra . If the continuous treatment rule is the law, they argued that it is inapplicable here because Altenburg's participation in Froysland's second surgery was a coincidence, rather than resulting from an ongoing physician-patient relationship. There are two branches of the continuing care idea: one of continuous treatment for medical malpractice and another of continuous representation for legal malpractice. We applied the continuous representation rule for legal malpractice in Wall v. Lewis : We believe that the continuous representation rule appropriately protects the integrity of the attorney-client relationship and affords the attorney an opportunity to remedy his error (or to establish that there has been no error), while simultaneously preventing the attorney from defeating the client's cause of action through delay. We conclude that it is appropriate to apply the continuous representation rule in attorney malpractice actions in this state. 393 N.W.2d at 763. Although the continuous representation rule originated as an adaptation of the continuous treatment rule, we have only applied the idea to legal malpractice so far. We discussed, but did not adopt or apply, the continuous treatment theory for the first time in Iverson v. Lancaster, 158 N.W.2d 507 (N.D.1968). Instead, we applied the rule that a statute of limitations did not begin to run until the plaintiff discovered, or could have discovered with reasonable diligence, the doctor's negligence. We implied that we might consider the continuous treatment rule in the future: The following excerpt from Hundley v. St. Francis Hospital, 161 Cal.App.2d 800, 327 P.2d 131, 80 A.L.R.2d 360 (1958), may indicate the direction in which it may be necessary to extend the rule [of discovery], dependent upon the facts: The rule is clear, as to malpractice actions, that while the physician-patient relation continues the plaintiff is not ordinarily put on notice of the negligent conduct of the physician upon whose skill, judgment and advice he continues to rely. (Citation omitted). . . .' 158 N.W.2d at 512. (Emphasis added). Thus, the continuing treatment concept is premised upon an ongoing and continuous relationship between patient and physician. The reasons underlying the rule are that a patient must trust a physician to remain in his care and that, during that care, the patient is not likely to suspect negligent treatment. It is the trust relationship that may make discovery of a claim difficult. The Minnesota Court of Appeals recently reviewed these rationales and summarized appropriate factors for determining when treatment ends: (1) whether there is a relationship between physician and patient with regard to the illness; (2) whether the physician is attending and examining the patient; and (3) whether there is something more to be done. (Citation omitted). Krause v. Farber, 379 N.W.2d 93, 96 (Minn.App. 1985). Thus, as a principle, continuous treatment anticipates something more than an isolated act of added attention by the physician more than two years after the initial conduct charged as injurious. Froysland had no follow-up care from Altenburg after the first surgery. There was no ongoing relationship with Altenburg and no contact of any kind with him for over two years. Anesthesia for Froysland's second surgery was coincidental and not part of a continuing pattern of care begun in 1983. Froysland was not lulled into sleeping on his rights by any ongoing connection with Altenburg. The statute for the first surgery had run its course and the claim was time-barred. The second surgery did not revive a claim whose time had expired. Froysland also grounds his claim of continuing treatment on the facts that he was seen and treated as a group patient by various doctors affiliated with the Fargo Clinic, from Devig and Altenburg for the first surgery through Altenburg and Johnson for and after the second surgery. The collective services of a medical clinic may sometimes call for a group patient extension of the continuous care concept, as the Minnesota Supreme Court has explained: ... [W]here the patient sought treatment from a clinic as a whole rather than an individual physician, the treatment of the clinic as a whole, rather than that of the individual physician alleged to have committed the act of malpractice, is relevant for purposes of determining when treatment terminated and the statute of limitations began to run. Offerdahl v. University of Minnesota, 426 N.W.2d 425, 428 (Minn.1988). But, Froysland's situation is quite different from Offerdahl's. Offerdahl saw several different doctors, assigned at random, in a single clinic in connection with the same health problem associated with intrauterine devices. Froysland interrupted his treatment at Fargo Clinic. Devig was done treating Froysland by April 9, 1984 and, by August 1984, had referred him to a physician not associated with Fargo Clinic, Habinger, who assumed Froysland's care. Referral to an outside physician interrupted the care by the clinic and its physicians. Referral to Habinger ended continuing care by Fargo Clinic. The subsequent association of those independent physicians with the clinic did not reinstate a relationship and thereby make it continuous in the sense contemplated by the rule. Froysland did not have an uninterrupted and continuing relationship with the Fargo Clinic from 1983 to 1985. Offerdahl also identified a single act exception to the general rule about termination of treatment: A practical reason for the general `termination of treatment rule' is that actionable treatment does not ordinarily consist of a single act or, even if it does, it is most difficult to determine the precise time of its occurrence. (Citation omitted). This concern is not present in this case, as Offerdahl has alleged an identifiable single act by the University as the basis for her negligence claim. Offerdahl's claim is in sharp contrast to the claim set forth in Schmitt [ v. Esser, 178 Minn. 82, 226 N.W. 196 (1929) ], where the precise negligent event could not be readily identified. (Citation omitted). Id., at 429. Like the continuous representation rule, which applies only when the attorney continues to represent the client and the representation relates to the same transaction or subject matter as the allegedly negligent acts, Wall, supra at 762, the continuous treatment rule should apply only to the same condition. Froysland asserted a single, readily ascertainable act of alleged negligence at the heart surgery. It was a distinct event. He knew about his potential claim for that single act when he approached St. Luke's Hospitals in early September 1984. More than two years went by before Froysland sued Altenburg and Fargo Clinic. Therefore, his claim was time barred. Were we to adopt the continuous treatment theory in North Dakota, Froysland's claim would clearly be outside the rule. Because there were no genuine issues as to any material fact about the statute of limitations, we affirm the summary judgment. ERICKSTAD, C.J., VANDE WALLE and GIERKE, JJ., and PEDERSON, Special Judge, concur. PEDERSON, Special Judge, sitting in place of LEVINE, J., disqualified.