Court Opinion

ID: 9639448
Source: CourtListenerOpinion
Date Created: 2023-08-22 16:18:17.033775+00
Date Added: 2024-06-11T18:10:18.717286
License: Public Domain

Justice BAER,
concurring and dissenting.
I agree with the majority that the Superior Court erroneously granted summary judgment in favor of Appellees/Defendants on the basis that Appellant’s medical malpractice action was time-barred. I am compelled to write, however, as I believe the convergence of this Court’s adoption of the certificate of merit (COM) requirements and our application of the discovery rule in medical malpractice cases has the potential for unbridled mischief. Application of current Pennsylvania jurisprudence places plaintiffs, like Appellant, in the precarious position of being constrained to file a lawsuit before they know whether their resulting symptoms are linked to a physician’s malpractice or are common side effects of the procedure performed. Such an absurd consequence resulting from the application of these two countervailing principles of law should not be countenanced. To avert this fundamental unfairness, we should construe the discovery rule so as to toll the statute of limitations until the plaintiff obtains, or with the exercise of *188due diligence should have obtained, medical evidence sufficient to enable the plaintiff to link her injury to the acts of the defendant. In the instant case, there is no genuine issue of material fact that the lawsuit was filed within two years of when Appellant, after diligent investigation, obtained medical evidence connecting her injury to Appellee Dr. El Daiefs actions. Thus, in my view, Appellant’s action was timely filed as a matter of law, and our mandate on remand should simply be for trial on the merits of Appellant’s claim.
My analysis begins with an examination of the landscape of medical malpractice jurisprudence in this Commonwealth, which was substantially transformed in 2003, when this Court adopted the COM requirements in the Pennsylvania Rules of Civil Procedure. See Pa.R.C.P. 1042.3-1042.8. The COM rules were adopted to curtail the filing of non-meritorious medical malpractice actions, and to provide an expeditious procedure for dismissal of cases filed notwithstanding their lack of merit. See Womer v. Hilliker, 589 Pa. 256, 908 A.2d 269, 275 (2006). The expectation was that this new requirement would reduce the burdens imposed upon litigants (e.g., physicians) and the courts by identifying and eliminating non-meritorious claims in an efficient and prompt manner. Id.
Specifically, to effectuate such purpose, Pa.R.C.P. 1043.2 provides that in a professional malpractice action, the plaintiff must file with the complaint, or within sixty days thereafter, a certificate of merit signed by the attorney or party attesting that:
an appropriate licensed professional has supplied a written statement that there exists a reasonable probability that the care, skill or knowledge exercised or exhibited in the treatment, practice or work that is the subject of the complaint, fell outside acceptable professional standards and that such conduct was a cause in bringing about the harm....
Pa.R.C.P. 1042.3(a)(1). The mandatory nature of the COM requirement and the sanction for failing to file a timely COM are made clear in Rule 1042.6, which requires the Prothonotary, upon praecipe of the defendant, to enter a judgment of non pros against the plaintiff for failing to file a COM within the *189requisite time period, provided no motion for extension has been filed by the plaintiff. Pa.R.C.P. 1042.6. Further, the plaintiff faces obstacles in opening a judgment of non pros entered pursuant to Rule 1042.6, as the sole avenue of relief is an appeal to the equitable powers of the court pursuant to Pa.R.C.P. 3051.1 Womer, 908 A.2d at 279.
Thus, plaintiffs must supply a timely statement from a licensed professional, indicating that the defendant’s conduct was a cause in bringing about their harm, or risk the entry of a snap judgment against them. Paradoxically, however, under the current state of the law in Pennsylvania, the statute of limitations commences in many cases before the plaintiff, despite the exercise of all due diligence, is able to obtain such a professional opinion. As the majority explains, Pennsylvania has adopted an approach to the discovery rule accepted by a minority of the states, which is grounded on inquiry notice and ties “commencement of the limitations period to actual or constructive knowledge of at least some form of significant harm and of a factual cause linked to another’s conduct, without the necessity of notice of the full extent of the injury, the fact of actual negligence, or precise cause.” Majority Opinion at 178, 964 A.2d at 364.
Under this approach, a plaintiff who has constructive knowledge of some harm, but does not know that such harm is the result of her physician’s actions, will be forced to commence a cause of action in order to comply with the ticking statute of limitations via the discovery rule, but will nevertheless find her case dismissed with prejudice under the COM rules as she will not be able to supply the requisite statement from a licensed professional to substantiate her claim.
Based upon our adoption of the COM requirements and to protect blameless plaintiffs who are unsuspecting of a possible malpractice claim due to the latent nature of their injury, as *190well as false assurances given by their treating physician, I would align Pennsylvania with most other jurisdictions adopting the view that equates the term “injury” with “legal injury,” and commences the statute of limitations when the plaintiff has actual or constructive knowledge, not of the harm, but of the cause of action associated with such harm. See Rathje v. Mercy Hosp., 745 N.W.2d 443, 452-53 (Iowa 2008) (collecting case and explaining that most courts “triggered the discovery rule upon knowledge of the cause of action, including at least some knowledge that the conduct of the physician was negligent or wrongful”). This approach is consistent with the specific requirements in the COM rules and with the public policy of reducing the number of frivolous medical malpractice actions filed by plaintiffs who are seeking to protect their interests before they obtain a medical diagnosis regarding the cause of their injury. Further, I note that this approach is not foreign to our jurisprudence, as it was essentially applied by the Superior Court in Caro v. Glah, 867 A.2d 531 (Pa.Super.2004), to a factual predicate remarkably similar to that presented here.
The majority candidly'recognizes that “were we to apply the view prevailing in most other jurisdictions requiring knowledge of a cause of action, it does not appear that the statute of limitations question would even be an issue for the jury in the present circumstances, since there appears to be no evidence that Appellant possessed evidence of wrongdoing, or enough information to understand she had a cause of action, before October 2001 [which was two years prior to the filing of the action on October 10, 2003].” Majority Opinion at 181, n. 12, 964 A.2d at 366, n. 12, citing Brin v. S.E.W. Investors, 902 A.2d 784, 793 (D.C.2006) (“Since patients must rely on their doctors, a person cannot reasonably be expected or required to act until that person has some medical advice to support a linkage between a known injury and wrongdoing of.which the person has some evidence.”).
This realization is compelling and must be remedied, particularly in a vehicle, such as this one, where the undisputed facts demonstrate a diligent investigation into the cause of *191Appellant’s injury, yet an inability to discover such cause due to repeated reassurances by the physician who purportedly caused the harm. Here, following her August 4, 2000 surgery, Appellant continued treating with Appellee (“Dr. El-Daief’) for the next thirteen months. During that time, after Appellant complained concerning her post-operative state, Dr. El-Daief referred her to orthopedic surgeon, James Nutt, M.D., who repeatedly referred her back to Dr. El-Daief. While Dr. Nutt reported to Dr. El-Daief a differential diagnosis encompassing four possibilities, one of which was a laceration of the radial nerve, neither Dr. El-Daief nor Dr. Nutt ever conveyed to Appellant the possibility that Dr. El-Daiefs malpractice was the cause of her maladies. At her last visit to Dr. Nutt’s office, he adamantly required that she return to Dr. El-Daief, who subsequently reassured her that nothing was wrong.2
At this point in time, in September of 2001, after nearly twenty medical appointments, Appellant had finally lost confidence in Dr. El-Daief, even though she remained unaware of the cause of her injury. On Óctober 10, 2001, less than three weeks after concluding that “something was wrong,” Appellant sought and visited a third physician, Dr. Scott Fried, who ultimately performed surgery on April 23, 2003, which revealed that Appellant’s maladies were likely the result of Dr. El-Daief having lacerated her radial nerve during her surgery in August 2000. It was not until this point in the proceedings that Appellant was aware of the cause of her injury. Further, and importantly, it was not until this point in the proceedings that Appellant possessed the knowledge necessary for her to obtain a certificate of merit from a medical professional, attesting to the fact that there exists a reasonable probability that Dr. El-Daiefs care fell outside acceptable professional standards and that such conduct was a cause in bringing about her injury. Appellant filed the instant action on October 10, 2003, less than seven months later. This record clearly estab*192lishes that Appellant’s investigation was not only diligent in ascertaining the existence and cause of her injury, but was unremitting. Under these circumstances, I would find, as a matter of law, that her action was timely filed.
This conclusion is on all fours with the Superior Court’s analysis in Caro, which recognized the tension between our application of the discovery rule and a plaintiffs duty to file a certificate of merit. In Caro, the plaintiff underwent surgery on her left knee in May of 1998. Following the surgery, she continued to experience pain, but the defendant/physician assured her that the pain would subside as the tissues healed. On July 14, 1999, the plaintiff obtained a second opinion from another physician, who merely encouraged her to continue treatment. Finally, on September 14, 1999, the plaintiff was examined by a third doctor, who informed her that she had suffered a fractured patella during the surgery performed by the defendant in 1998. The plaintiff did not commence her action within two years of when she incurred the injury, but filed it on September 13, 2001, within two years of receiving the medical diagnosis of the injury and its cause.
As in the instant case, the trial court granted the defendant’s motion for summary judgment on the grounds that the action was untimely. The Superior Court reversed, concluding, as a matter of law, that the plaintiffs action was filed within the requisite two-year period. The court found that the plaintiff diligently investigated, but did not become aware of her injury or who caused it until she consulted with the third physician on September 14, 1999, and therefore the discovery rule applied to toll the statute of limitations on her claims. Id. at 537.
The Superior Court set forth the identical analysis as set forth herein to the extent it concluded that the statute of limitations could not have commenced in July of 1999, when the plaintiff lost confidence in her physician, because the plaintiff would have been unable to comply with the certificate of merit requirements of Pa.R.C.P. 1042.3(a) at that time. Id. at 538. The court ruled that, in light of the new requirements of Rule 1042.3, evidence that an injured party appeared to *193have lost confidence in his or her physician, without more, is insufficient to trigger the running of the statute of limitations where a plaintiff has diligently sought to discover the cause of his or her injury. Id.
I would adopt the approach taken in Caro and conclude that, where a plaintiff has diligently sought to discover the cause of his or her injury, the statute of limitations begins to commence when the plaintiff obtains medical evidence sufficient to enable the plaintiff to link his or her injury to the acts of the defendant, and thereby possesses the requisite knowledge to obtain a COM in support of the claim asserted.3
Applying such law to the facts presented, I would conclude that Appellant engaged in a diligent investigation into the nature and cause of her injury, and that there is no genuine issue of material fact that she was unaware of the nature of her injury and its cause until she obtained the medical diagnosis from Dr. Fried on April 23, 2003.4 Thus, I would conclude that Appellant’s action filed on October 10, 2003 was timely filed as a matter of law.
Justice McCAFFERY joins this concurring and dissenting opinion.

. To obtain relief under Rule 3051, a plaintiff in a medical malpractice action must demonstrate that: (1) the petition to open the judgment of non pros is timely filed; (2) there is a reasonable explanation or legitimate excuse for the inactivity, here, the failure to file the COM; and (3) there is a meritorious cause of action. Pa.R.C.P. 3051.

. While it is not in the record, as a matter of common sense, we can divine that Dr. Nutt was appreciative of Dr. El-Daief’s referral of this as well as other patients, and was not about to jeopardize the referral relationship by explaining to Appellant that Dr. El-Daief’s malpractice was the cause of her difficulties.

. Contrary to the majority, I respectfully do not view this approach as constituting a policy decision reserved for the legislature. While it is clear that the ultimate issue lies in whether the statute of limitations has been satisfied, the approach advocated herein concerns not the statute itself, but rather the interplay of the judicially-created discovery rule and the court-imposed rules of civil procedure. Thus, I believe that it is within our judicial authority and, in fact, our obligation to reexamine our precedent in light of the countervailing interests discussed herein.

. I acknowledge that a determination of whether the discovery rule applies will ordinarily be left for the jury because ordinarily there will be genuine issues of material fact. See Fine v. Checcio, 582 Pa. 253, 870 A.2d 850, 858 (2005) (providing that a jury ordinarily determines whether the discovery rule applies because such issue involves a factual determination as to whether a party was able, in the exercise of reasonable diligence, to know of the injury and its cause). In the instant case, however, it is undisputed that Appellant was unaware of the nature of her injury or its cause until she obtained the medical diagnosis from Dr. Fried on April 23, 2003. As there are no facts to submit to a jury, the general rule as established in Fine is inapplicable to this case.