Opinion ID: 2452215
Heading Depth: 1
Heading Rank: 1

Heading: The Survival Claim

Text: Article 4590i, section 10.01 provides the limitations period for medical malpractice actions: Notwithstanding any other law, no health care liability claim may be commenced unless the action is filed within two years from the occurrence of the breach or tort or from the date the medical or health care treatment that is the subject of the claim or the hospitalization for which the claim is made is completed.... TEX.REV.CIV.STAT.ANN. art. 4590i, § 10.01 (Vernon Supp.1995). Although the statute specifies three dates from which the limitations period may run, a plaintiff cannot simply choose among any of these dates. Kimball v. Brothers, 741 S.W.2d 370, 372 (Tex. 1987). If the injury results from a negligent course of treatment, rather than a specific instance of negligence, the limitations period begins on the last date of treatment. Id. However, when the precise date of the breach or tort is ascertainable, the limitations period begins on that date. Id. The court of appeals held that the Maxwells' claim was based on Dr. Bala's continuing treatment for a stomach lesion, and there was no ascertainable date of the tort. The court of appeals relied on Chambers v. Conaway, 883 S.W.2d 156 (Tex.1993), in reaching this conclusion. In Chambers, the plaintiff complained to her family physician about a lump in her breast. The physician ordered a mammogram, and determined that the lump was benign. Three years later, the plaintiff underwent a second mammogram, from which the physician determined `everything [was] fine.' Id. at 157. Between the first and second mammograms, and after the second mammogram, the physician treated the plaintiff on numerous occasions for other problems. After the second mammogram, she never again mentioned problems with her breasts. Eventually, she was diagnosed with breast cancer by another doctor. In response to the doctor's summary judgment motion, the plaintiff presented an affidavit from a doctor who stated that, if a patient complains of a lump in her breast, a family physician has a duty to follow-up on this condition during subsequent visits. This evidence tended to establish that the defendant was negligent in each office visit after the plaintiff's initial complaint about her breast. Thus, the limitations period did not begin until the last of these office visits. Id. at 158. Unlike Chambers, this case does not involve multiple failures to perform follow-up tests. The Maxwells allege that Dr. Bala was negligent in 1987 because he failed to order additional tests after the biopsy report stated malignancy could not be ruled out. The next time Dr. Bala examined Maxwell was in 1989. During the 1989 examination, Dr. Bala ordered the third EGD, and the results of this test led to the diagnosis of cancer. Thus, any negligence could only have occurred in 1987. The Maxwells suggest that, by failing to diagnose the cancer in 1987, and therefore not initiating a course of treatment for the cancer, Dr. Bala's negligence continued until the cancer was discovered. We have previously held that when a physician fails to diagnose a condition, the continuing nature of the diagnosis does not extend the tort for limitations purposes. Rowntree v. Hunsucker, 833 S.W.2d 103, 108 (Tex.1992). `While the failure to treat a condition may well be negligent, we cannot accept the self-contradictory proposition that the failure to establish a course of treatment is a course of treatment.' Id. at 105-06 (quoting Nykorchuck v. Henriques, 78 N.Y.2d 255, 573 N.Y.S.2d 434, 434, 577 N.E.2d 1026, 1029 (1991)). Rowntree also involved claims that a physician had breached his duty to perform tests which would have revealed the patient's high blood pressure, which ultimately lead to a stroke. This Court found that the doctor could have breached this duty only on those occasions when he had opportunity to perform such [follow-up] examinations. Id. at 108. Likewise, Dr. Bala could have breached a duty to perform additional tests only when he examined Maxwell in 1986, 1987, or 1989. Because no signs of malignancy appeared in 1986, and Dr. Bala ordered tests which led to the diagnosis of cancer in 1989, a negligent failure to conduct follow-up procedures could have only occurred in connection with the December 1987 examination and EGD. We conclude that the limitations period commenced at that time.