Opinion ID: 1539955
Heading Depth: 1
Heading Rank: 9

Heading: Medical Negligence Act Affidavit Of Merit Requirement

Text: The General Assembly's enactment of section 6853 in 2003 did not alter the date on which the injury occurred for purposes of the beginning of the limitations period under section 6856. Therefore, the Superior Court erred as a matter of law when it held that, in cases where the allegedly negligent act is a failure to diagnose a condition, and that failure does not immediately cause an injury, the statute of limitations does not begin to run until the date on which the plaintiff first could have submitted an affidavit of merit that satisfies the requirements of section 6853. In the 2003 amendments to the Delaware Medical Negligence Act, the General Assembly established the requirement, under section 6853, that all complaints alleging medical negligence be accompanied by an affidavit of merit, signed by a qualified expert witness and stating that there are reasonable grounds to believe that each defendant has committed medical negligence. [40] Section 6853 requires that the affidavit of merit set forth the expert's opinion that there are reasonable grounds to believe that the applicable standard of care was breached by the named defendant(s) and that the breach was a proximate cause of injury(ies) claimed in the complaint. [41] Section 6856 was also amended in 2003 to establish a 90-day tolling period for prospective plaintiffs to investigate their potential claims. [42] The synopsis of the bill to amend the statutes provides: This Act requires an Affidavit of Merit signed by an expert witness to be obtained before a healthcare negligence lawsuit can be filed. Certain time periods for action are determined and a process for an extension is spelled-out. Expert Witness qualification requirements are set. Additionally a process to allow up to ninety (90) days to investigate a potential negligence claim is added and would extend the medical malpractice statute of limitations accordingly. It is expected that this grace period will give plaintiffs an opportunity to determine whether a potential claim has merit and will result in some lawsuits that might otherwise be filed not being filed. Finally, this Act requires healthcare providers to provide patients copies of their medical records within forty-five (45) days from the date the request is received. [43] Nothing in the synopsis of the legislation or the actual bill amending the Act suggests that the General Assembly intended to affect this Court's holdings in Dunn and Meekins about when the injury occurred for purposes of the statute of limitations under section 6856. Repeal or modification of a statute by implication is disfavored unless the provisions of the later statute relating to the same subject are so inconsistent with, and repugnant to, the prior Act that they cannot be reconciled on any reasonable hypothesis. [44] It is not enough that the later statute is different; it must be contrary to the prior Act. [45] The Superior Court concluded that, prior to the enactment of section 6853, a plaintiff could file a medical negligence complaint before the extent to which the negligence proximately caused her injury was known. In Meekins, this Court stated: In theory, Meekins could have brought an action at [the time of] the allegedly negligent diagnosis, although her damages would be difficult to quantify. [46] In Meyer's case, the Superior Court concluded that, following the enactment of section 6853, this Court's observation was no longer accurate because [a] plaintiff's cause of action for medical negligence does not accrue until such time as she is able to secure an affidavit of merit from a competent expert who is prepared to opine that the health care defendant(s) breached the applicable standard(s) of care and that such breach(es) proximately caused the plaintiff's injuries. [47] Therefore, the Superior Court explained, [n]o longer can a plaintiff file a complaint for medical negligence when the causation of injury is not yet established to a reasonable degree of medical probability. [48] The Superior Court's interpretation of section 6853 and its implications on the statute of limitations is not supported by either the plain language of the statute or the prior decisions of this Court. In Dunn v. St. Francis Hospital , this Court held that the general theory of negligence under the common law, which requires a showing of negligence, proximate cause, and damage to establish a cause of action, does not apply to medical negligence claims. [49] In Dunn, this Court determined that the clear thrust of the statute, passed in response to a particular issue in a particular context, was to render proximate cause analysis unnecessary in medical negligence claims. [50] Injury, therefore, is not related to the manifestation of damages resulting from the injury. It occurs at the time of the allegedly negligent act or omission. [51] In Beckett v. Beebe Medical Center , this Court explained that the affidavit of merit requires `that expert medical testimony be presented to allege a deviation from the applicable standard of care' for the purpose of reduce[ing] the filing of meritless medical negligence claims. [52] The General Assembly intended that a qualified medical professional would review a plaintiff's claim and determine that there are reasonable grounds to believe that the health care provider has breached the applicable standard of care that caused the injuries claimed in the complaint. [53] Accordingly, the affidavit of merit simply required Meyer to make a prima facie showing that there are reasonable grounds to believe that negligence has occurred and caused an injury, as defined by this Court in Meekins. In Meyer's case, therefore, the expert had to give his opinion that there were reasonable grounds to believe that Meyer's cancer existed on March 8, 2005, and that the defendants misread Meyer's mammogram results on that date. The injury was the existence of the cancer, which the defendants failed to detect during the March 8, 2005, exam. The injury was not the cancer's later metastasis. If the cancer did not exist on March 8, 2005, then the defendants were not negligent in failing to detect it. The defendants' failure to detect the presence of cancer on March 8, 2005, caused Meyer's cancer to go undetected and untreated until her next mammogram. The failure to detect cancer was the negligent act and the resulting injury was that the cancer went untreated. Therefore, the negligent act and the injury occurred at the same time, when the defendants failed to diagnose Meyer's cancer on March 8, 2005. There is no indication in the plain language of sections 6853 and 6856 or in the synopses of the legislation amending the statutes in 2003 to conclude that the 2003 amendments were intended to add a proximate cause component to the allegation of injury necessary to assert a claim for medical negligence. As we stated in Dunn, [t]he statutory context and history makes it unnecessary for us to explore when damage occurred in the context the plaintiff argues. [54] Further, the 2003 amendments did not alter this Court's holding in Meekins that the statute of limitations begins to run on the date of the injury, which is the date the alleged negligent act or omission occurred. In this case, the Superior Court's interpretation that the 2003 amendments to the Medical Negligence Act rendered this Court's holding in Meekins to be no longer accurate constituted legal error. We conclude that the enactment of section 6853 did not alter this Court's interpretation of when the statute of limitations begins to run under section 6856. Therefore, the Superior Court erred as a matter of law when it interpreted section 6853 as extending the statute of limitations in cases where the alleged negligent act is failure to diagnose cancer or some other disease.