Court Opinion

ID: 9963599
Source: CourtListenerOpinion
Date Created: 2024-04-25 20:14:10.985952+00
Date Added: 2024-06-11T08:24:53.826893
License: Public Domain

140 Nev., Advance Opinion   31
                          IN THE COURT OF APPEALS OF THE STATE OF NEVADA

                    KEITH BOMAN,                                        No. 86005-COA
                    Appellant,
                    vs.
                    MICHAEL ELKANICH, M.D., AN
                                                                            'NLED
                    INDIVIDUAL; AND BONE & JOINT                             APR 2 5 2024
                    SPECIALISTS,
                    Respondents.

                               Appeal from a district court order granting a motion to dismiss
                    in a professional negligence action. Eighth Judicial District Court, Clark
                    County; Veronica Barisich, Judge.
                                Reversed and remanded.

                    Hymanson & Hymanson and Ariana Caruso, Henry J. Hymanson, and
                    Philip M. Hymanson, Las Vegas,
                    for Appellant.

                    McBride Hall and Heather S. Hall and Robert C. McBride, Las Vegas,
                    for Respondents.

                    BEFORE THE COURT OF APPEALS, GIBBONS. C.J., and BULLA and
                    WESTBROOK, JJ.

                                                    OPINION

                    By the Court, BULLA, J.:
                                In this opinion, we address whether irrefutable evidence existed
                    to support the district court's determination of the accrual date in a
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                   professional negligence action, thereby warranting dismissal of the case
                   pursuant to the applicable one-year statute of limitation.'       Because we
                   conclude that factual disputes remain regarding the relevant accrual date,
                   the district court erred in dismissing the complaint as untimely as a matter
                   of law under NRCP 12(b)(5).        In reaching our decision, we apply the
                   reasoning of Massey v. Litton, 99 Nev. 723, 728, 669 P.2d 248, 252 (1983), a
                   summary judgment case, in the context of a motion to dismiss, to conclude
                   that a patient is "fully entitled to rely on the physician's professional skill
                   and judgment" while under the physician's care, which, in this case,
                   precluded the district court frorn finding—as a matter of law—that
                   irrefutable evidence existed to support its determined accrual date.
                   Therefore, we reverse the judgment of the district court.
                                     FACTS AND PROCEDURAL HISTORY
                               In 2019, appellant Keith Boman, a board-certified cardiologist,
                   experienced pain radiating from his spine.        Boman initially saw Gary
                   Flangas, M.D., who referred him to a pain management specialist for
                   epidural injections. When his condition did not improve with the injections,
                   Boman presented to respondents, Dr. Elkanich with Bone & Joint
                   Specialists, in September 2020. Following a review of Boman's x-rays and
                   MRI scans, Dr. Elkanich diagnosed Boman with severe lumbar spinal

                         'We note that recent amendments to NRS 41A.097 extend the statute
                   of limitations for professional negligence claims to two years after the
                   plaintiff discovers or should have discovered the injury, but only for claims
                   arising on or after October 1, 2023. See Secretary of State, Statewide Ballot
                   Question No. 3, § 8 (Nev., effective Nov. 23, 2004); NRS 41A.097(2)-(3); 2023
                   Nev. Stat., ch. 493, § 3. at 3023-24. As the claims in this case arose before
                   October 1, 2023, these amendments do not affect this court's analysis.
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                     stenosis.2   Dr. Elkanich provided Boman with two treatment options:
                     continue with epidural injections or undergo a laminectomy surgery from
                     L2-S1.3 Boman opted for surgery.
                                  Approximately one month later, on October 19, 2020, Dr.
                     Elkanich performed the larninectomy at MountainView Hospital. When
                     Boman awoke from surgery, he had no feeling or movement in his left leg.
                     Dr. Elkanich then informed Boman that his spinal cord dura was
                     apparently "nicked," and then repaired, during surgery.4 Dr. Elkanich also
                     told Boman that the issues he was experiencing with "his left leg can occur
                     and should improve over time."
                                  After 24 hours of bed rest, Boman felt severe lower back pain at
                     the site of his incision and had not regained feeling or movement in his left
                     leg, except for slight movement in his toes. After three days, Boman was
                     transferred to the rehabilitation facility at MountainView Hospital where
                     he continued experiencing pain. At Boman's request, Dr. Elkanich ordered
                     an MRI on October 24, which showed a "6 [by] 5.1-centimeter-deep

                           2"Spinal stenosis is the narrowing of one or more spaces within [the]
                     spinal canal. [The] spinal canal is the tunnel that runs through each of the
                     vertebrae in [the] spine." Spinal Stenosis: What It Is, Causes, Syrnptorns &
                     Treatrnent, Cleveland Clinic, https://my.clevelandclinic.org/health/diseases/
                     17499-spinal-stenosis (last reviewed by a Cleveland Clinic medical
                     professional on June 30, 2023).

                           3According to Boman's complaint, "[a] laminectomy is a procedure
                     where all or part of the vertebral bone (lamina) is removed to help ease
                     pressure on the spinal cord and offer relief from pain and neurological
                     conditions."

                           4According to Boman's complaint, "[t]he spinal cord dura is a  thick
                     membrane of dense   irregular  connective  tissue that surrounds the brain
                     and spinal cord and protects the central nervous system."
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                   hematorna that was crowding the nerve roots" around his lumbar and sacral
                   region, called the cauda equina. Two days later, Dr. Elkanich performed
                   surgery to remove the hematoma at MountainView Hospital. Following
                   surgery, Boman's lower back pain lessened, but the feeling in his left leg did
                   not return.
                                 Boman returned to the rehabilitation facility, where he stayed
                   for approximately two weeks. When he was discharged on November 13,
                   Boman "was still experiencing significant leg weakness, numbness, and
                   paralysis of his left foot." Thereafter, Boman began physical therapy three
                   times a week for five months. He also continued to be treated by Dr.
                   Elkanich. According to Bornan, at his appointment on January 5, 2021, "Dr.
                   Elkanich downplayed the continued post-surgery complications . . . Boman
                   was experiencing by telling [him] that 'it's only been three months since
                   surgery with your symptoms." On April 23, Dr. Elkanich referred Boman
                   to Dr. Flangas for a second opinion.        At his June 1, 2021, referral
                   appointment, Dr. Flangas purportedly told Boman, for the first time, that
                   his "symptoms were consistent with cauda equina syndrome with
                   exacerbation from the post-operative hematorna."5 Boman claims it was at
                   this appointment that he was placed on inquiry notice as to Dr. Elkanich's
                   potential professional negligence.
                                 Within one year after his appointment with Dr. Flangas, on
                   June 1, 2022, Boman filed a complaint against Dr. Elkanich and

                         5Cauda   equina syndrome is the compression of the cauda equina
                   nerve roots. Cauda Equina Syndrome: Symptoms, Treatment & Causes,
                   Cleveland Clinic, https://my.clevelandclinic.org/health/diseases/22132-
                   cauda-equina-syndrome (last reviewed by a Cleveland Clinic medical
                   professional on Nov. 22, 2021). "Compressed cauda equina nerves can cause
                   pain, weakness, incontinence and other symptoms." Id.
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                   Bone & Joint Specialists, alleging six claims for relief, including
                   professional negligence; negligent hiring, training, supervision, and/or
                   credentialling/privileging; and corporate negligence/vicarious liability.6 Dr.
                   Elkanich and Bone & Joint Specialists moved to dismiss the complaint,
                   arguing that Boman's complaint was untimely because he filed it after the
                   one-year statute of limitations under NRS 41A.097 (2004) had expired.7 In
                   support of their position, respondents assert that the statute of limitations
                   accrued no later than the date Boman was discharged from the hospital in
                   2020 because, at that time, Boman was placed on inquiry notice of his
                   potential claims against Dr. Elkanich, as he had learned of the nicked dura
                   and hematoma and experienced neurological symptoms.
                                Following a hearing, the district court found that Boman was
                   on inquiry notice of his legal injury on October 19, 2020, when Dr. Elkanich

                   stated that he nicked the dura, or on October 24, 2020, at the latest, when
                   Boman underwent an MRI at his request that showed the presence of a
                   hematoma requiring surgery. Therefore, the district court determined that
                   Boman filed his June 1, 2022, complaint well beyond the applicable one-
                   year statute of limitations from the date of accrual in October 2020 and
                   accordingly dismissed it.8 Boman timely appealed.

                         6 Boman also sued MountainView Hospital, Sunrise Health System,
                   and HCA Healthcare, Inc. But those parties and the claims against them
                   were dismissed below and are not before this court on appeal.

                         7 The initial motion to dismiss we are considering on appeal was filed
                   by MountainView Hospital, Sunrise Health System, and HCA Healthcare,
                   Inc., and later joined by Dr. Elkanich and Bone & Joint Specialists.

                         8The district court denied a different motion to dismiss filed by
                   respondents, but that issue is not before us in this appeal.
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                                                    ANALYSIS
                               On appeal, Boman argues that the district court erred in its

                   interpretation of the terms "injury" and "discovers" set forth in NRS
                   41A.097.   Bornan contends that if the court had properly interpreted
                   "injury" to mean a legal injury and interpreted "discovers" to mean having
                   inquiry notice of a negligence cause of action, then the court could not have

                   determined that Boman had discovered his legal injury on October 24, 2020,
                   at the latest. Boman specifically argues that he was not placed on inquiry
                   notice of his potential professional negligence claims against respondents
                   until June 1, 2021, when he presented to Dr. Flangas for a second opinion.

                   Therefore, Boman claims that he timely filed his complaint within one year
                   after the accrual date.
                               In turn, respondents argue that the district court properly
                   found that Boman was first placed on inquiry notice of a professional
                   negligence claim against Dr. Elkanich in October 2020 when he became
                   aware of his surgical injuries and experienced symptoms, rather than at his
                   June 1, 2021, visit with Dr. Flangas. Therefore, respondents argue that,
                   because Boman was on inquiry notice as of October 2020, the district court
                   correctly dismissed his complaint          because   the one-year statute of
                   limitations had expired when Boman filed his complaint on June 1, 2022.
                               "A district court's order granting a motion to dismiss under
                   NRCP 12(b)(5) is reviewed de novo." Nelson u. Burr, 138 Nev., Adv. Op. 85,
                   521 P.3d 1207, 1210 (2022). A "complaint should be dismissed only if it
                   appears beyond a doubt that [the plaintiff] could prove no set of facts, which,
                   if true, would entitle [the plaintiff] to relief." Buzz Stew, LLC u. City of
                   North Las Vegas, 124 Nev. 224, 228, 181 P.3d 670, 672 (2008). This rigorous
                   standard requires this court to recognize all factual allegations in the
                   plaintiffs complaint as true and draw all inferences in favor of the moving
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                   party. Id. at 227-28, 181 P.3d at 672; see also Nelson, 138 Nev., Adv. Op.
                   85, 521 P.3d at 1210. "[A] court can dismiss a complaint under NRCP
                   12(b)(5) 'if the action is barred by the statute of limitations." Engelson v.
                   Dignity Health, 1.39 Nev., Adv. Op. 58, 542 P.3d 430, 436 (Ct. App. 2023)
                   (quoting Bemis v. Est. of Bemis, 114 Nev. 1021, 1024, 967 P.2d 437, 439
                   (1998)).
                               NRS 41A.097(2) provides that "an action for injury . . . against
                   a provider of health care may not be commenced more than 3 years after
                   the date of injury or 1 year after the plaintiff discovers or through the use
                   of reasonable diligence should have discovered the injury, whichever occurs
                   first." "Thnjury' as used in NRS 41A.097[ ] means legal injury." Massey, 99
                   Nev. at 726, 669 P.2d at 251. A legal injury includes "both the 'physical
                   damage' and the `[professional] negligence causing the damage." Engelson,
                   139 Nev., Adv. Op. 58, 542 P.3d at 437 (alteration in original). "[A] plaintiff
                   discovers his injury when he knows or, through the use of reasonable
                   diligence, should have known of facts that would put a reasonable person
                   on inquiry notice of his cause of action." Winn v. Sunrise Hosp. & Med. Ctr.,
                   128 Nev. 246, 252, 277 P.3d 458, 462 (2012) (internal quotation marks
                   omitted). "[A] person is put on 'inquiry notice' when he or she should have
                   known of facts that 'would lead an ordinarily prudent person to investigate
                   the matter further." Id. (quoting Inquiry Notice, Black's Law Dictionary
                   (9th ed. 2009)). "[T]hese facts need not pertain to precise legal theories the
                   plaintiff may ultimately pursue, but merely to the plaintiff's general belief
                   that someone's negligence may have caused his or her injury." Id. at 252-
                   53, 277 P.3d at 462. "The discovery may be either actual or presumptive,
                   but must be of both the fact of damage suffered and the realization that the
                   cause was the health care provider's negligence." Massey, 99 Nev. at 727,

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                   669 P.2d at 251. The accrual date is generally a question of fact to be
                   decided by the jury; however, the district court rnay determine the accrual
                   date as a matter of law when the evidence is irrefutable. Winn, 128 Nev. at
                   251, 277 P.3d at 462.
                               In Massey, following hip replacement surgery, the plaintiff
                   experienced a loss of sensation in her left leg and foot. 99 Nev. at 724, 669
                   P.2d at 249. The plaintiffs treating physician "told [her] that it was not
                   unusual or permanent and that physical therapy would result in an
                   improvement." Id. The plaintiff continued under the treating physician's
                   care for many months, and during this time, the physician maintained that
                   the condition would improve. Id. However, six months after the surgery,
                   the physician changed course "when he expressed his inability to explain
                   [plaintiffs] condition." Id.
                               The plaintiff subsequently sued the physician, who moved to
                   dismiss her complaint on the ground that it was untimely, asserting that
                   the statute of limitations started running on the date that the plaintiff
                   discovered her symptoms. Id. at 725, 669 P.2d at 250. The Nevada Supreme
                   Court disagreed, noting that the patient-plaintiff "commended herself to
                   [the physician's] care and continuing treatment" and that a "patient is fully
                   entitled to rely upon the physician's professional skill and judgment while
                   under his care, and has little choice but to do so." Id. at 728, 669 P.3d at
                   252 (quoting Sanchez v. S. Hoover Hosp., 553 P.2d 1129, 1135 (Cal. 1976)).
                   The supreme court stated that "during the continuance of this professional
                   relationship, which is fiduciary in nature, the degree of diligence required
                   of a patient in ferreting out and learning of the negligent causes of his
                   condition is diminished." Id. (quoting Sanchez, 553 P.2d at 1135). Thus,
                   the supreme court held that "it [was] not clear" when the plaintiff was, or

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                   should have been, aware of her cause of action during the time she remained
                   under the physician's care. Id. On that basis, and upon treating the order
                   granting the motion to dismiss as one for summary judgment because the
                   district court considered matters outside the pleadings, the supreme court
                   concluded that summary judgment was inappropriate. Id. at 742 n.1, 728.
                   669 P.2d at 249 n.1, 252.
                               Ma.ssey was resolved on a summary judgment basis, and
                   therefore the district court considered evidence regarding whether the
                   plaintiff had discovered his legal injury more than two years (the statute of
                   limitations at the time) before filing the complaint. Id. at 728, 669 P.2d at
                   252; Wood v. Safeway, Inc., 121 Nev. 724, 731, 121 P.3d 1026, 1031 (2005)
                   (setting forth the summary judgment standard and providing that a court
                   is to consider "the pleadings, depositions, answers to interrogatories,
                   admissions, and affidavits, if any, that are properly before the court" when
                   ruling on a summary judgment motion); Cuzze v. Univ. & Cmty. Coll. Sys.
                   of Nev., 123 Nev. 598, 602-03, 172 P.3d 131, 134 (2007) (providing that,
                   when the party that bears the burden of persuasion at trial is the
                   nonmoving party in a request for summary judgment, they "must transcend
                   the pleadings and, by affidavit or other admissible evidence, introduce
                   specific facts that show a genuine issue of material fact" to avoid summary
                   judgment). Although the summary judgment standard does not apply here,
                   as this case was resolved on a motion to dismiss, and the district court did
                   not consider evidence in making its decision, Massey is still instructive. Its
                   legal holdings concerning a patient's ability to rely on a treating physician's
                   advice during the time of treatment and the diminished diligence required
                   of a patient to discover their legal injury during this time apply equally

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                   when considering whether to grant a dismissal or summary judgment. See
                   Massey, 99 Nev. at 728, 669 P.2d at 252.
                               Here, in considering whether the district court erred in
                   granting a dismissal, we take Boman's allegations as true and draw every
                   inference in Boman's favor. See Buzz Stew, 124 Nev. at 227-28, 181 P.3d at
                   672.   Applying the rules promulgated in Massey, we conclude that the
                   district court erred in finding that, as a matter of law, Boman was on
                   inquiry notice of his legal injury by October 24, 2020, at the latest. Although
                   Dr. Elkanich informed Boman that the dura was nicked during surgery and
                   repaired, and surgically addressed the hematoma, Dr. Elkanich also
                   advised Boman that the issues he experienced in his leg could occur
                   following surgery and should improve over time.           Additionally, three
                   months after the surgery, Dr. Elkanich purportedly downplayed Boman's
                   neurological complications involving his left leg, again suggesting that he
                   would improve. Because Boman was under Dr. Elkanich's continued care,
                   he was fully entitled to rely upon Dr. Elkanich's skill and judgment, and the

                   degree of diligence required of him to learn of any alleged negligence was
                   diminished.9 See Massey, 99 Nev. at 728, 669 P.2d at 252; see also Engelson,
                   139 Nev., Adv. Op. 58, 542 P.3d at 439 (determining there was not
                   irrefutable evidence that the plaintiff had inquiry notice because the record

                          9Respondents further argue that this court should consider Boman's
                   experience as a cardiologist as irrefutable evidence that he knew or should
                   have known about his injury as of October 24, 2020, at the latest. However,
                   respondents cite no authority to support their position that, because Boman
                   is a doctor, as a patient he was not entitled to rely on the information Dr.
                   Elkanich provided him regarding his treatment and diagnosis.             See
                   Edwards v. Emperor's Garden Rest., 122 Nev. 317, 330, n.38, 130 P.3d 1280,
                   1288 n.38 (2006) (explaining that this court need not consider an argument
                   that is not cogently argued or lacks the support of relevant authority).
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                   did not state that the patient or plaintiff "were actually informed by the
                   hospital staff that her condition had in fact worsened and, more specifically,
                   was the result of professional negligence").
                               Therefore, at this stage of the proceedings, irrefutable evidence
                   does not exist to support that Boman was on inquiry notice of his legal
                   injury either on October 19, 2020, when he learned about the nicked dura
                   and his leg paralysis, or on October 24, 2020, when he learned about the
                   hematoma because of his ongoing physician-patient relationship with Dr.
                   Elkanich.   See Winn, 128 Nev. at 251, 277• P.3d at 462.          Taking the
                   allegations in the complaint as true and all inferences in Boman's favor, as
                   we must, Boman was unaware of the possibility of his continuing health
                   issues being related to Dr. Elkanich's alleged negligence until he sought a
                   second opinion from Dr. Flangas on June 1, 2021, at which time he learned
                   of his diagnosis of cauda equina syndrome and the effect the post-operative
                   hematoma had on his outcome. Thus, at this stage of the proceedings, there
                   is no irrefutable evidence that the statute of limitations had expired when
                   Boman filed his complaint, and factual disputes remain regarding the
                   accrual date of the statute of limitations on Boman's claims.
                                                  CONCLUSION
                               Taking all factual inferences in favor of Boman in considering
                   whether dismissal of his complaint was appropriate under NRCP 12(b)(5)
                   and applying the reasoning set forth in Massey, we conclude that irrefutable
                   evidence does not support, that as of October 24, 2020, at tbe latest, Boman
                   was placed on inquiry notice of his claims against Dr. Elkanich. Indeed,
                   Boman's degree of diligence was diminished while he remained under Dr.
                   Elkanich's care during this period, particularly when Boman alleges that
                   Dr. Elkanich continually reassured him that his post-operative condition
                   would improve. Because factual disputes remain regarding the relevant
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                   accrual date, the district court erred in dismissing Boman's complaint as
                   being untimely as a matter of law under NRCP 12(b)(5). And we note that
                   if genuine disputes regarding inquiry notice remain following discovery,
                   then the determination of the accrual date is a question of fact for the jury
                   or trier of fact to resolve.   Winn, 128 Nev. at 251, 277 P.3d at 462.10
                   Accordingly, we reverse and remand this matter to the district court for
                   further proceedings consistent with this opinion.

                                                        Bulla

                   We concur:

                   Gibbons r/

                                                   J.

                         1"Insofar  as the parties have raised arguments that are not
                   specifically addressed in this opinion, we have considered the same and
                   conclude that they either do not present a basis for further relief or need not
                   be reached given the disposition of this appeal.
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