Court Opinion

ID: 9698717
Source: CourtListenerOpinion
Date Created: 2023-08-25 19:58:16.326239+00
Date Added: 2024-06-11T18:20:42.950492
License: Public Domain

TERRY, Associate Judge,
dissenting:
I cannot agree with the majority’s analysis of this case. In my view, there is a material issue of fact affecting the application of the discovery rule, and thus the case should not have been decided on summary judgment.
In the District of Columbia, an action for medical malpractice must be brought within three years “from the time the right to maintain the action accrues.” D.C.Code § 12-301(8) (1989). In deciding when a cause of action for medical malpractice accrues for purposes of the statute of limitations, this court has applied the “discovery rule.” Burns v. Bell, 409 A.2d 614, 617 (D.C.1979). Under that rule, a cause of action does not accrue until the plaintiff knows, or by the exercise of reasonable diligence should know, of (1) the injury, (2) its cause in fact, and (3) some evidence of wrongdoing. Bussineau v. President & Directors of Georgetown College, 518 A.2d 423, 425 (D.C.1986).
The application of the discovery rule in this case depends on the definition of “injury.” Mr. Colbert contends that the metastasis of his wife’s cancer is the relevant injury. He asserts that he and his wife were not aware of any injury until they learned definitively that Mrs. Colbert’s cancer had metastasized to her spine and hip. The Colberts admitted that they were aware of Dr. Lee’s negligence in not performing a mastectomy in August of 1982, but they maintained below, and Mr. Colbert maintains on appeal, that they did not believe that the failure to perform a mastectomy in August of 1982 caused any ultimate harm to Mrs. Colbert until they discovered the metastasis in September of 1986. The hospital and Dr. Lee claim that the relevant injury for purposes of the discovery rule was the initial breast ean-cer. They assert that the Colberts were aware of that injury and of the defendants’ negligence in 1982. Their argument assumes that the metastasis of Mrs. Colbert’s cancer was merely a manifestation of that initial, and controlling, injury.
The plaintiffs’ state of mind is the paramount factor in this court’s definition of the relevant injury for purposes of the discovery rule. We have held that, under the discovery rule, “[t]he key issue is [the plaintiffs] knowledge of some injury, its cause, and related wrongdoing.” Knight v. Furlow, 553 A.2d 1232, 1236 (D.C.1989), citing Bussineau, supra, 518 A.2d at 425. Our cases show that we tend to look askance at trial court rulings that purport to decide such an issue on motions for summary judgment. For example, in Ehrenhaft v. Malcolm Price, Inc., 483 A.2d 1192 (D.C.1984), we concluded that the relevant inquiry was “whether genuine issues of material fact exist as to when appellant knew, or with reasonable diligence could have known, of the ... defects for which he seeks damages.” Id. at 1204. We held that “this determination cannot be made in a summary manner.... [Whether] appellant knew or should have known of the alleged defects for more than three years at the time the complaint was filed ... is a question to be decided by the trier of fact.” Id. (citations omitted).1
According to the reasoning of Ehrenhaft and Knight, the outcome of this case depends on what the Colberts believed (or reasonably should have believed) as to the potential metastasis of Mrs. Colbert’s cancer. If the Colberts were reasonable in their belief that they were not injured by the negligence of Dr. Lee until they discovered the metastasis of the cancer in September of 1986, then the cause of action did not accrue until September of 1986. If that belief was not reasonable, then their awareness of injury occurred, and their cause of action accrued, much earlier.2
*477In other jurisdictions which apply the discovery rule, a majority of courts confronted with the issue presented here have held that a patient’s awareness of metastasis is the relevant trigger for purposes of the statute of limitations. A Florida appellate court, for instance, reversed a trial court’s grant of summary judgment on statute of limitations grounds and held that the plaintiffs assertion that she did not believe she had been injured by the defendants’ failure to diagnose her cancer until the discovery of metastasis presented a genuine issue of material fact:
At the time the radical mastectomy was performed, she had no cause of action against appellee doctor because there was no evidence that his alleged negligence had resulted in any harm to her. It was only in February 1975, when the cancer appeared in other parts of her body, that she discovered her cause of action.
Johnson v. Mullee, 385 So.2d 1038, 1040 (Fla. Dist.Ct.App.1980), review denied, 392 So.2d 1377 (Fla.1981). The Illinois Appellate Court has similarly held that the reasonableness vel non of the plaintiffs belief that she had not been injured until she discovered the metastasis of her cancer was a genuine issue of material fact. Marciniak v. O’Connor, 102 Ill.App.3d 381, 386-87, 58 Ill.Dec. 504, 507, 430 N.E.2d 536, 539 (1981); see also Catz v. Rubenstein, 201 Conn. 39, 49, 513 A.2d 98, 103 (1986); Jennings v. Brabson, supra note 2. But see Silverman v. Lathrop, 168 N.J.Super. 333, 403 A.2d 18 (1979) (plaintiffs cause of action for medical malpractice accrued at the time he discovered the doctor’s negligence; upon making that discovery, plaintiff had a duty to investigate whether melanoma spot had metastasized). The majority rule is consistent with District of Columbia case law, specificaUy with Ehrenhaft, Bussineau, and Knight, and I would adopt it here for the District of Columbia.
In defining “injury” for purposes of the discovery rule, several courts have explicitly recognized that the metastasis of cancer gives rise to a cause of action distinct from that stemming from the original cancerous injury. The Supreme Court of Arizona has said that “[w]here a medical malpractice claim is based on a misdiagnosis or a failure to diagnose a condition ... the ‘injury’ is the development of the problem into a more serious condition which poses greater danger to the patient or which requires more extensive treatment.” DeBoer v. Brown, 138 Ariz. 168, 170, 673 P.2d 912, 914 (1983) (citations omitted). In reversing a trial court’s grant of summary judgment in a medical malpractice case, the Illinois Appellate Court defined the relevant injury for purposes of the discovery rule as the metastasis of the original cancer: “The evidence adduced primarily through affidavits and depositions indicates a disputed material fact as to when plaintiff knew or, through use of reasonable diligence, should have known of her injury, the metastasis of the malignant schwannoma to lymph nodes in her groin.” Kaplan v. Berger, 184 Ill. App.3d 224, 231-32, 132 Ill.Dec. 461, 466, 539 N.E.2d 1267, 1272 (1989) (emphasis added); see also Whitaker v. Zirkle, 188 Ga.App. 706, 706-08, 374 S.E.2d 106, 108 (1988) (“The injury complained of is the subsequent metastasis of cancerous ceUs”). In each of these cases, the plaintiff had discovered both the presence of cancer and the negligence of her doctor long before she discovered that the cancer had metastasized. The plaintiffs assertion that it was the discovery of metastasis, rather than the original diagnosis of cancer, that triggered the statute of limitations was viewed to be reasonable enough for jury consideration in each instance.
The case at bar foUows the same pattern. The Colberts admitted that they discovered Dr. Lee’s negligence in 1982. They asserted, however, that they did not discover that his negligence caused a compensable injury— the second factor that starts the clock running under Bussineau — until the ultimate diagnosis of metastasis in 1986. The affidavits of Mr. and Mrs. Colbert, Mrs. Colbert’s answers to interrogatories, and Mr. Colbert’s deposition testimony aU reflect their belief that Mrs. Colbert had at least a fair possibili*478ty of full recovery until she learned of the metastasis. The Colberts’ belief that they had not been injured until the manifestation of metastasis was further supported by the evidence that the doctors had consistently told the Colberts that the cancer might be forever cured.3
The defendants’ assertion that the Col-berts were aware of the spread of Mrs. Colbert’s cancer before September of 1986 ignores several important facts. It is certainly true that the Colberts were told at least twice before September of 1986 that the cancer had metastasized. But each of these instances ultimately proved to be a false alarm. The record indicates that the presence of metastatic cancer was not conclusively determined until September 2 or 3, 1986;4 every other supposed discovery of metastasis was tentative or preliminary and was later refuted. Given the substantial possibility that breast cancer will metastasize and the relative frequency of the false alarms, the Colberts’ belief that Mrs. Colbert was not injured until the ultimate diagnosis may not seem reasonable to a jury. But that belief at least presents an issue of material fact which a jury should be allowed to resolve.5
There are additional reasons to view the Colberts’ discovery of metastatic cancer as a clock-starting injury for purposes of the statute of limitations. First, Ehrenhaft and other cases6 make clear that the plaintiffs’ interest in the protection afforded by the discovery rule is more compelling than the defendants’ interest in not having to deal with stale claims. The resulting obligation to defend which rests on the defendant is “somewhat tempered by the fact that the burden of proof remains upon the plaintiff.” Ehrenhaft, supra, 483 A.2d at 1202 (citation omitted). Moreover, it is well recognized that statutes of limitations are merely “statutes of repose,” which do not bestow any fundamental right on defendants. Rather, they “find their justification in necessity and convenience rather than in logic. They represent expedients, rather than principles.” Chase Securities Corp. v. Donaldson, 325 U.S. 304, 314, 65 S.Ct. 1137, 1142, 89 L.Ed. 1628 (1945). Such statutes can and do remove valid claims from judicial consideration and prevent injured plaintiffs from being compensated for their injuries. Thus, in the application of any statute of limitations, it is the plaintiffs fundamental interest in the adjudication of a meritorious claim which must be balanced against the defendant’s interest in repose.
*479A holding that the discovery of metastatic cancer can start the running of the statute of limitations would also obviate the filing of a speculative lawsuit whenever a patient discovers any form of cancer. In Ehrenhaft we rested our holding in part on “the interests of judicial economy,” concerned that our failure to apply the discovery rule to cases involving latent construction defects would “encourage litigation in the first instance, rather than as a last resort.” 483 A.2d at 1203 (citations omitted). The United States Court of Appeals in Wilson, supra note 6, focused on this same risk in holding that the “manifestation of any asbestos-related disease” does not trigger the running of the statute of limitations on “a separate and distinct disease” caused by the same asbestos exposure “until that disease becomes manifest.” 221 U.S.App.D.C. at 338, 684 F.2d at 112 (emphasis added). The court noted that if Mr. Wilson had just one indivisible cause of action for all potential consequences of his exposure to asbestos which accrued at the onset of any illness, he would have “a powerful incentive to go to court” at that time with a claim for future damages which would at best be speculative and uncertain, and hence unable to support a damage award. Id. at 345, 684 F.2d at 120. The incentive to file claims for unknowable future injuries “would result in the imposition of an unnecessary burden on the judicial system.” Pierce, supra note 6, 296 Md. at 667, 464 A.2d at 1027.
The interests of judicial economy also favor reversal in the instant case. If the Col-berts’ cause of action for all potential injuries had accrued upon their discovery of Dr. Lee’s negligence in 1982, they would have been obliged to file speculative claims for any injury which might someday afflict them. Such claims would be very likely to fail and leave the Colberts — or others like them— with no remedy for the metastasis allegedly caused by their doctor’s initial negligence. Judicial time and effort would nevertheless be required to reject such claims. Allowing persons such as the Colberts to bring suit after they discover the metastasis of cancer would provide them with an effective remedy for their alleged injuries.
I would therefore hold that there is a genuine issue of material fact as to when the Colberts discovered their injury. In my view, the Colberts have submitted enough evidence to raise a genuine issue as to that critical question, precluding summary judgment based on the statute of limitations. Because the majority has a different view of the case, I respectfully dissent.

. "Summary judgment is often inappropriate where state of mind is crucial to the ultimate factual issue.” Attorney General v. Irish People, Inc., 254 U.S.App.D.C. 229, 233, 796 F.2d 520, 524 (1986) (citations omitted); see Poller v. Columbia Broadcasting System, Inc., 368 U.S. 464, 473, 82 S.Ct. 486, 491-92, 7 L.Ed.2d 458 (1962).

. In a case factually similar to the case at bar, the Tennessee Court of Appeals held that there was a genuine issue of material fact as to when the plaintiff’s cause of action for malpractice accrued under the discovery rule. "The issue before us is not whether [the plaintiff] knew that *477she had cancer in July 1987; she admits to having this knowledge. The larger issue is whether she reasonably should have known that the condition would metastasize. If so, her action is barred, otherwise it is not.” Jennings v. Brabson, No. 1402, 1991 WL 50209, *2, 1991 Tenn.App. LEXIS 241, *4 (Tenn.Ct.App. April 10, 1991).

. The disparity of knowledge between patients and their doctors is one of the main reasons why this court has adopted the discovery rule in medical malpractice cases. "To require a patient to scrutinize to a fine degree the advice given by a treating physician, at the risk of losing his right to legal redress, seems unwise." Burns v. Bell, supra, 409 A.2d at 617.

. Appellees assert that the metastasis was conclusively established no later than August 30, 1986. On that date, Mrs. Colbert’s internist did inform the Colberts that x-rays of Mrs. Colbert's back were abnormal and suggested the possibility of metastasis — but only a possibility. The internist also recommended further tests, which were not conducted until September 2 or 3. It was those tests that finally confirmed the metastasis of Mrs. Colbert's breast cancer to her hip and spine.
The trial court did not decide whether the preliminary results of the August 30 x-rays satisfied the discovery rule, since it rested its grant of summary judgment on the conclusion that the relevant discovery occurred in 1982. I see no need, however, to remand the case for a specific ruling on the August 30 conversation between Mrs. Colbert and her internist, because I am satisfied that the Colberts' assertion that they did not conclusively discover metastatic cancer until several days later is clearly reasonable enough to raise a genuine issue of fact.

. Appellees also assert that the Colberts could have sued for malpractice in 1982. The availability of an earlier suit may help the jury to determine whether the Colberts' belief that no injury had occurred was reasonable. It does not conclusively determine when their cause of action accrued, however, because the relevant focus is on the Colberts’ state of mind. Even assuming that the Colberts could have brought this action in 1982, the apparent fact that Mrs. Colbert had fully recovered (which only later turned out to be untrue) may well have led them to believe they had no viable claim until they discovered that the cancer had metastasized. The possibility of an earlier suit does not make such a belief unreasonable. See Abhoud v. Viscomi, 111 N.J. 56, 64-66, 543 A.2d 29, 33 (1988).

. E.g., Wilson v. Johns-Manville Sales Corp., 221 U.S.App.D.C. 337, 684 F.2d 111 (1982); Pierce v. Johns-Manville Sales Corp., 296 Md. 656, 464 A.2d 1020 (1983); Larson v. Johns-Manville Sales Corp., 427 Mich. 301, 399 N.W.2d 1 (1986).