Court Opinion

ID: 9745120
Source: CourtListenerOpinion
Date Created: 2023-08-26 22:35:55.164605+00
Date Added: 2024-06-11T07:24:56.232608
License: Public Domain

O’ROURKE, J., Concurring and Dissenting.
I respectfully dissent. I disagree with that portion of the majority’s opinion holding that Kitzig presented evidence from which the jury could reasonably infer “she did not suspect her continuing dental problems were caused by Dr. Nordquist’s wrongdoing.” (Maj. opn., ante at p. 1394.) The majority’s holding ignores settled law on accrual of causes of action and the delayed discovery exception to the statute of limitations, and is contrary to Kitzig’s unequivocal admission that over one year before she filed suit she “suspected [Dr. Nordquist] did something wrong” to her, prompting her to seek out another dentist’s opinion. The majority’s unprecedented “meaningful suspicion” rule effectively creates a new tolling rule permitting a malpractice plaintiff who (a) experiences the effects of actual malpractice and (b) actually suspects her physician’s negligence, to toll the statute of limitations indefinitely until another healthcare provider expressly confirms or diagnoses the negligent treatment. Such a rule is not the law in California.
*1403At issue is the proper interpretation and application of the discovery exception to the one-year statute of limitations of Code of Civil Procedure section 340.5 (section 340.5). Norgart v. Upjohn Co. (1999) 21 Cal.4th 383 [87 Cal.Rptr.2d 453, 981 P.2d 79] (Norgart) contains the California Supreme Court’s most recent discussion of statutes of limitations, accrual of causes of action and section 340.5’s discovery rule. In Norgart, the court explained: “ ‘Statute of limitations’ is the ‘collective term . . . commonly applied to a great number of acts,’ or parts of acts, that ‘prescribe the periods beyond which’ a plaintiff may not bring a cause of action. [Citations.] It has as a purpose to protect defendants from the stale claims of dilatory plaintiffs. [Citations.] It has as a related purpose to stimulate plaintiffs to assert fresh claims against defendants in a diligent fashion. [Citations.] Inasmuch as it ‘necessarily fix[es]’ a ‘definite period[] of time’ [citation], it operates conclusively across the board, and not flexibly on a case-by-case basis. [Citations.]” (21 Cal.4th at p. 395.)
Recognizing that courts have described the affirmative defense based upon the statute of limitations as both “favored” for providing repose and “disfavored” for promoting disposition on the merits, the court in Norgart clarified that the affirmative defense should not be characterized as favored or disfavored because both stated public policies are “equally strong, the one being no less important or substantial than the other.” (Norgart, supra, 21 Cal.4th. at p. 396.) Regardless of the policies, Norgart makes it clear it is for the Legislature alone to establish the period under any statute of limitations. (Ibid.) A plaintiff, of course, must file suit within the limitations period after accrual of the cause of action. (Norgart, supra, 21 Cal.4th at p. 397.)
Norgart summarized the accrual rules as follows: “The general rule for defining the accrual of a cause of action sets the date as the time ‘when, under the substantive law, the wrongful act is done,’ or the wrongful result occurs, and the consequent ‘liability arises . . . .’ [Citation.] In other words, it sets the date as the time when the cause of action is complete with all of its elements [citations]—the elements being genetically referred to by sets of terms such as ‘wrongdoing’ or ‘wrongful conduct,’ ‘cause’ or ‘causation,’ and ‘harm’ or ‘injury’ [citations].” (Norgart, supra, 21 Cal.4th at p. 397.)
Under the “discovery rule,” accrual of a cause of action is postponed until the plaintiff actually discovers, or has reason to discover, the elements of the cause of action. (Norgart, supra, 21 Cal.4th at p. 397; Jolly v. Eli Lilly & Co. (1988) 44 Cal.3d 1103, 1110 [245 Cal.Rptr. 658, 751 P.2d 923].) Addressing a cause of action for wrongful death, the court explained that the date of accrual is the “date on which the plaintiff comes at least to suspect, or have *1404reason to suspect, a factual basis for its elements.” (Norgart, supra, at p. 405.) Norgart explains that determination is assessed, at least in part, from the layperson’s viewpoint: “[A] plaintiff discovers the cause of action when he at least suspects a factual basis, as opposed to a legal theory, . . . when, simply put, he at least ‘suspects . . . that someone has done something wrong’ to him [citation], ‘wrong’ being used, not in any technical sense, but rather in accordance with its ‘lay understanding’ [citation].” (Id. at pp. 397-398.) Norgart makes clear that discovery of a cause of action is met by mere suspicion of wrongdoing; contrary to Kitzig’s arguments on appeal, the plaintiff need not have actual knowledge of the elements of her claim.1 As the majority points out, reaching the point of actual suspicion differs from the point at which one reasonably should suspect her physician was negligent, although both will trigger the statute. Under the latter standard, plaintiff has reason to suspect wrongdoing when she has notice or information of circumstances to put a reasonable person on inquiry, she need not know the specific facts necessary to establish the cause of action. (Norgart, supra, at p. 398; Jolly v. Eli Lilly & Co., supra, 44 Cal.3d at p. 1110-1111.) Harsh a rule as it may be, our high court unambiguously holds that where the plaintiff does not have actual suspicion of wrongdoing, the statute in any event can begin to run when a plaintiff reaches the point of inquiry notice, that is, when she has information prompting a reasonable person to make inquiry about her claim, not when she confirms the accuracy or validity of her suspicions or acquires sufficient evidence to succeed on her claim. (Cf. Jolly v. Eli Lilly & Co., supra, 44 Cal.3d at p. 1111 [the acquisition of specific “facts” necessary to establish a claim is a process contemplated by pretrial discovery].)
Kitzig argued on appeal that the jury was entitled to base its finding the statute did not begin to run upon “circumstantial evidence” contradicting her direct admission that she actually suspected Dr. Nordquist’s wrongdoing. The majority agrees, holding there is evidence demonstrating Kitzig never reached the “requisite” suspicion to trigger the statute in the first place. As I explain, Kitzig’s admission, together with evidence of her physical condition at the time, demonstrates suspicion of wrongdoing sufficient to trigger the *1405statute of limitations. The majority’s holding that the evidence shows Kitzig did not actually reach that suspicion is flawed because the evidence either does not support the majority’s characterization, or is legally irrelevant to a proper statute of limitations analysis.
At trial, Kitzig admitted that as of May 20, 1994 she suspected that Dr. Nordquist had committed wrongdoing to a degree that caused her to consult with another dentist:
“Q. [Defense counsel] . . . Prior to this date of January 12, 1995, did you, in your own mind, ever think that Dr. Nordquist had done anything wrong?
“A. [Kitzig] The only time I found out that Dr. Nordquist did anything wrong was March 21st when Dr. Simpson told me they [the implants] were all failing.
“Q. [Defense counsel] Well, my question’s a little different. I’m asking did you ever suspect, not that you were told, but did you ever suspect that Dr. Nordquist had done something wrong?
“A. [Kitzig] I suspected he did something wrong when that hole was there.
“Q. [Defense counsel] When did you first suspect that Dr. Nordquist had done something wrong?
“A. [Kitzig] I think it was when I went to—to LA to the UCLA [sic] for the doctor to check that hole that water and bubbles were coming out of. [¶]... [¶]
“Q. [Defense counsel] You went to see that UCLA doctor on May 20, 1994; is that correct?
“A. [Kitzig] Yes.
“Q. [Defense counsel] And I think you said at that point in time you thought Dr. Nordquist had done something wrong?
“A. [Kitzig] I was suspicious because I had that hole in my sinus and water and bubbles were coming out, yes.
“Q. [Defense counsel] So you were suspicious that Dr. Nordquist had done something wrong?
“A. [Kitzig] Yes. [¶] . . . [¶]
*1406“Q. [Defense counsel] Mrs. Kitzig, was your chief complaint when you went to see the doctor at UCLA that you wanted the truth about what your dentist was planning to do?
“A. [Kitzig] I wanted him to examine the implants and tell me about that hole in my sinus.
“Q. [Defense counsel] And that’s because you suspected at that point in time your state of mind was that Dr. Nordquist had done something wrong; correct?
“A. [Kitzig] I had suspected so, yes.”
At the time of her visit to Dr. Nishimura, Kitzig was aware that an implant had entered her sinus; she had been told by Dr. Nordquist that she had a “hole in [her] sinus” that would probably close on its own; and she was experiencing food and bubbles exiting from her nose as a result of the hole. At this point, Kitzig had “discovered” her cause of action: she had knowledge of injury (the opening); suspicion of wrongdoing; and suspicion that the injury was caused by Dr. Nordquist’s improper care. Her admission of suspected negligence, together with her testimony describing the physical conditions that prompted her visit to Dr. Nishimura, conclusively establish that the statutory period commenced in May 1994. (See, e.g., Norgart, supra, 21 Cal.4th 383, 405-406 [plaintiff’s admissions that around the time of his daughter’s death he suspected that “something wrong” had happened to her to cause her death and that he had formed a belief that an “individual or individuals” did something wrong to cause her to take her own life, including her psychiatrist’s professional negligence, held sufficient to establish suspicion of factual basis for and accrual of wrongful death cause of action]; Sanchez v. South Hoover Hospital (1976) 18 Cal.3d 93, 102 [132 Cal.Rptr. 657, 553 P.2d 1129] (Sanchez) [regardless of a possibility of an earlier commencement, plaintiff’s deposition testimony established the statute of limitations began to run upon plaintiff’s release from the hospital, at which time she thought defendants “ ‘had done something wrong because of all the time that I stayed there suffering’ ”]; Gray v. Reeves (1977) 76 Cal.App.3d 567, 572, 576-577 [142 Cal.Rptr. 716] [plaintiff admitted in his deposition that he knew defendants “did something wrong” by prescribing medication; that admission, combined with plaintiff’s prior knowledge of hip problems, established commencement of the statute of limitations]; Graham v. Hansen (1982) 128 Cal.App.3d 965, 972-973 [180 Cal.Rptr. 604] [plaintiff’s action was barred by the statute of limitations as a matter of law where plaintiff *1407testified that before she was released from the hospital she suspected her doctor committed malpractice; plaintiff had information with respect to her injury and its cause sufficient to place a reasonable person on inquiry as to the probability of actionable conduct on the part of defendants].) Because the evidence demonstrates, as a matter of law, that the statutory period commenced over one year before Kitzig filed her lawsuit, her negligence claim against Dr. Nordquist is barred.
The majority concedes the statute of limitations is commenced where there is evidence a person actually suspects “1 “that someone has done something wrong” to him.’ ” (Maj. opn., ante, at p. 1393, citing Norgart and Sanchez.) It further concedes that a patient’s reliance on her physician’s assurances that his treatment is adequate “may not be justified if the patient actually suspects wrongdoing.” (Ibid., citing Sanchez.) But the majority proceeds to hold the patient’s suspicion must be “meaningful by having some effect on the patient’s ongoing relationship with her doctor.” (Ibid., citing Brown v. Bleiberg (1982) 32 Cal.3d 426, 438, fn. 9 [186 Cal.Rptr. 228, 651 P.2d 815] (Brown).) In footnote 9, Brown addressed the rule that, during the continued physician/patient relationship, a patient is entitled to rely upon the physician’s assurances to lessen her duty to discover her cause of action. (See Sanchez, supra, 18 Cal.3d at p. 102; Unjian v. Berman (1989) 208 Cal.App.3d 881, 885 [256 Cal.Rptr. 478] (Unjian).) As the majority acknowledges, however, the continuing physician-patient relationship exception presumes that an injured plaintiff has not yet discovered or suspected physician negligence as the cause of her injuries due to her physician’s assurances to the contrary. In Unjian, the court explained: “Where . . . the injury is obvious but there is nothing to connect that injury to defendant’s negligence it cannot be said as a matter of law the plaintiff’s failure to make an earlier discovery of fault was unreasonable. [Citation.] This is especially true in cases . . . where the plaintiff continues under the doctor’s care, does inquire about the cause of his apparent injury and is given an explanation calculated to allay any suspicion of negligence on the doctor’s part.” (Unjian, supra, 208 Cal.App.3d at p. 885 italics added; see also Brown, supra, 32 Cal.3d at p. 434 [court held summary judgment inappropriate because “reasonable minds could differ ... as to the sufficiency of plaintiff’s explanation that she was prevented from suspecting defendants’ negligence by Dr. Bleiberg’s misrepresentations about the nature of the surgery he performed and why he performed it”].)
The physician-patient relationship exception has no application here because Kitzig actually suspected Dr. Nordquist’s negligence when she visited Dr. Nishimura at UCLA on May 20, 1994. Nevertheless, even under the majority’s cited authority, its novel “meaningful suspicion” test would be *1408met in this case. In Brown, the court explained that a patient’s reliance on the fiduciary role of her doctor can continue even after their relationship ends, assuming there is no evidence suggesting the patient lost trust in her doctor. It said: “During the continuation of the [physician/patient] relationship, courts have given plaintiffs the benefit of an ‘assumption’ of continued reliance so that the tolling effect of nondisclosure or concealment will also continue absent unusual circumstances which should put the patient on notice thereof. [Citations.] Such reliance on the fiduciary role of the physician may naturally continue after the physician-patient relationship has terminated, though. [Citation.] There was nothing in the circumstances in which plaintiff discontinued her treatment by Dr. Bleiberg to suggest any loss of trust in him.” (Brown, supra, 32 Cal.3d at p. 438, fn. 9, italics added.)
Contrary to the circumstances in Brown, the evidence here demonstrates Kitzig lost trust in Dr. Nordquist because she ignored Dr. Nordquist’s assurance that the hole was nothing unusual, and, fearing his negligence, proceeded to make inquiry about his treatment with a second dentist. In short, Kitzig did not believe Dr. Nordquist. “If evidence exists which shows that the patient does not take the physician’s ‘assurances at face value,’ then it may be . . . that the ‘diminished duty to discover period’ has either terminated or has been attenuated.” (Unjian, supra, 208 Cal.App.3d at p. 887; see Sanchez, supra, 18 Cal.3d at p. 102.) Thus, even assuming Kitzig had not already suspected negligence but rather operated under only a diminished duty to discover Dr. Nordquist’s negligence during his ongoing treatment, that period of diminished duty terminated (and she reached a “meaningful suspicion”) when she rejected Dr. Nordquist’s assurances and sought an opinion from Dr. Nishimura.
The majority’s reliance on the “continuous representation” doctrine to find Kitzig’s suspicion allayed by Dr. Nishimura’s statements is misplaced. Although that doctrine permits a patient to reasonably rely upon her negligent doctor’s advice and assurances (absent, of course, the patient’s discovery of her cause of action), it has not been extended to advice by any other physician with whom the patient consults. If the Legislature intended the law to be that a plaintiff may reasonably rely upon any physicians’ comforting advice regardless of her suspicions, it would enact an express tolling exception in section 340.5 similar to that within the legal malpractice statute of limitations. (§ 340.6; Laird v. Blacker (1992) 2 Cal.4th 606, 609 [7 Cal.Rptr.2d 550, 828 P.2d 691] [the statute of limitations for legal malpractice is tolled during the times, inter alia, when “the negligent attorney continues to represent the client”].) As Norgart pointed out, it is for the Legislature, not courts, to carve tolling exceptions to the statute of limitations.
*1409Also flawed is the majority’s reasoning that Kitzig’s suspicions were insufficient because they did not pertain to the “injury” serving as the basis of her negligence claim. (Maj. opn., ante at p. 1392.) Specifically, the majority claims that at trial Kitzig’s experts did not identify the creation of the sinus hole as a specific instance of Dr. Nordquist’s negligence. (Maj. opn., ante, at p. 1393.) This claim is contradicted by Kitzig’s expert’s testimony that Dr. Nordquist’s negligence began at the outset when he formulated his treatment plan and was evidenced by, among other things, “perforations into sinuses.” Even Kitzig argued on appeal that Dr. Nordquists’s failing bone augmentations caused the implants to push up into her sinus. More importantly, the majority’s approach departs from settled law that “injury,” as used in section 340.5, is not synonymous with the wrongdoing or negligent act. Rather, injury refers to evident, appreciable harm or detrimental effect of wrongdoing. (Larcher v. Wanless (1976) 18 Cal.3d 646, 655, 656, fn. 11 [135 Cal.Rptr. 75, 557 P.2d 507] [“injury” is a word of art which refers to the damaging effect of the negligence rather than the act of negligence itself and thus often refers to an event occurring some time after the commission of a wrongful act]; Steketee v. Lintz, Williams & Rothberg (1985) 38 Cal.3d 46, 54 [210 Cal.Rptr. 781, 694 P.2d 1153] [“ ‘Wrongful act’ and ‘injury’ are not synonymous”]; Brown, supra, 32 Cal.3d at p. 437, fn. 8 [elaborating that a plaintiff’s injury occurs at the point at which appreciable harm was first manifested].); Marriage & Family Center v. Superior Court (1991) 228 Cal.App.3d 1647, 1652 [279 Cal.Rptr. 475].) Based on her and her own expert’s testimony, there can be no doubt Kitzig, at the time of her UCLA visit, was experiencing the damaging effects of Dr. Nordquist’s negligence.
Contrary to the majority’s view, the jury’s finding on the statute of limitatipns is not supported by substantial evidence. In order for evidence to be substantial, it must be of ponderable legal significance, reasonable in nature, credible, and of solid value. (People v. Johnson (1980) 26 Cal.3d 557, 576 [162 Cal.Rptr. 431, 606 P.2d 738, 16 A.L.R.4th 1255]; Buckley v. California Coastal Com. (1998) 68 Cal.App.4th 178, 192 [80 Cal.Rptr.2d 562]; Kruse v. Bank of America (1988) 202 Cal.App.3d 38, 51-52 [248 Cal.Rptr. 217].) Although inferences can serve as substantial "evidence, the trier of fact may not “ ‘indulge in inferences rebutted by clear, positive and uncontradicted evidence. [Citation.]’ [Citation.]” (Western Digital Corp. v. Superior Court (1998) 60 Cal.App.4th 1471, 1487 [71 Cal.Rptr.2d 179].) Kitzig’s admission that she suspected Dr. Nordquist’s wrongdoing simply cannot be contradicted by inferences that might be drawn from her return to Dr. Nordquist for further treatment.
Further, under the substantial evidence standard, while we examine the facts in the light most favorable to Kitzig, “resolv[ing] all explicit conflicts *1410in the evidence in favor of the respondent and presum[ing] in favor of the judgment all reasonable inferences” (Kuhn v. Department of General Services (1994) 22 Cal.App.4th 1627, 1632 [29 Cal.Rptr.2d 191], italics omitted) this does not mean the court may affirm a judgment on inferences that do not “rest on the evidence.” (Ibid.) Here, the evidence does not support several of the majority’s characterizations. For example, Kitzig’s visit to Dr. Nishimura cannot reasonably be characterized as a “second opinion based on a subjective ‘concern’ with a patient’s ongoing treatment.” (Maj. opn., ante, at p. 1393.) There is a significant difference between obtaining a second opinion about a doctor’s medical conclusion or treatment decision, and mating inquiry with another doctor specifically to ascertain whether your first doctor committed negligence. The only inference a jury can reasonably draw from the testimony surrounding the purpose of Kitzig’s visit with Dr. Nishimura is that the latter occurred.
Nor does the evidence support the majority’s characterization of Dr. Nishimura’s statement to Kitzig as an assurance that Dr. Nordquist was “ ‘doing nothing wrong.’ ” (Maj. opn., ante, at p. 1393.) Dr. Nordquist had advised Kitzig that the hole in her sinus would probably close on its own, yet, according to Kitzig and her husband, Dr. Nishimura told her to “go back and get the hole closed.” Dr. Nishimura’s advice clearly contradicted Dr. Nordquist’s sanguine assessment of the hole. Similarly, the jury cannot reasonably draw an inference that, upon Kitzig’s return, Dr. Nordquist gave Kitzig express assurances that his treatment was adequate. The evidence indicates that the “assurances” by Dr. Nordquist after her UCLA visit were not assurances that his past treatment was satisfactory or explanations that Kitzig’s problems were attributable to something other than his inadequate care.2 At best, Kitzig’s testimony demonstrates that Dr. Nordquist-concealed information, e.g., Dr. Nordquist never told her and her husband thá^pliything was wrong; Dr. Nordquist never told her that he could not perforril the sinus surgery. In any event, after a plaintiff discovers the nature of her injury and its negligent origin thus triggering the one-year limitations period, concealment by the defendant is irrelevant. “[N]ondiscovery will toll the running of the one-year provision for adults. Concealment by the defendant physician will not toll this period if discovery has occurred. [Citations.]” (Young v. Haines (1986) 41 Cal.3d 883, 901 [226 Cal.Rptr. 547, 718 P.2d 909]; Sanchez, supra, 18 Cal.3d at pp. 98, 100-101 [“The applicable decisional law . . . has rejected any notion that nondisclosure by defendant would toll the *1411statute despite discovery by plaintiff’].) Assuming a jury could reasonably infer Dr. Nordquist somehow gave Kitzig the impression that “everything was okay” after her visit with Dr. Nishimura, such assurances made by Dr. Nordquist after May 20, 1994 would be relevant only to toll the three-year limitations period of section 340.5, not the one-year period.
The evidence also fails to support the majority’s reasoning that Kitzig “should not ... be expected to file a lawsuit against her current doctor when she subjectively and justifiably believes the lawsuit would be merit-less.” (Maj. opn., ante, at p. 1394.) Kitzig may have subjectively believed that Dr. Nordquist did nothing wrong after her visit with Dr. Nishimura, but as indicated by her experts’ testimony, she had ample justification and legal basis at that time to file a lawsuit against Dr. Nordquist based upon his manifest negligent care and treatment.3 Because her suspicions were reasonably founded, a lawsuit brought at that time would not have been premature, (Gutierrez v. Mofid (1985) 39 Cal.3d 892, 896-897 [218 Cal.Rptr. 313, 705 P.2d 886] [when a patient’s reasonably founded suspicions have been aroused and she has actually become alerted to the necessity for investigation and pursuit of her remedies, the one-year period for suit begins].)
Finally, evidence sufficient to support a jury verdict must actually be “ ‘substantial’ proof of the essentials which the law requires in a particular case.” (Kasparian v. County of Los Angeles (1995) 38 Cal.App.4th 242, 260 [45 Cal.Rptr.2d 90].) In other words, if evidence (or an inference drawn from evidence) supports a legally untenable proposition, it cannot serve as substantial evidence to support a judgment. Facts supporting erroneous legal principles are not of ponderable legal significance nor possessed of solid value. (See, e.g., Zemke v. Workmen’s Comp. App. Bd. (1968) 68 Cal.2d 794, 798 [69 Cal.Rptr. 88, 441 P.2d 928].) The inferences advanced by Kitzig and adopted by the majority to uphold the jury’s finding on the statute of limitations are without ponderable legal significance because (1) they are contradicted by Kitzig’s express admissions; and (2) they are used to buttress a faulty premise: that suspicion of wrongdoing sufficient for a patient to make inquiry about possible negligence must be confirmed by another physician or accompanied by a change in the doctor/patient relationship. Consequently, I give such facts no weight in the search for substantial evidence to support the jury’s finding.
*1412For these reasons, I would reverse the judgment and order denying the motion for partial judgment notwithstanding the verdict as to Kitzig’s negligence cause of action because no substantial evidence supports the jury’s finding as to the statute of limitations. Given my conclusion, I would not reach the issue relating to Proposition 51, as it would have no application to Kitzig’s remaining breach of contract claim.
I concur with the remainder of the majority’s opinion.
The petition of defendants and appellants for review by the Supreme Court was denied October 3, 2000.

In Norgart the court explained that language from Jolly v. Eli Lilly & Co., supra, 44 Cal.3d 1103 should not be read to require “knowledge” as long as suspicion of all the elements exists: “Not inconsistent with the proposition that the plaintiff discovers the cause of action when he at least suspects a factual basis for its elements, even if he lacks knowledge thereof, is language like that which appears in Jolly, to the effect that a ‘suspicion’ of one or more of the elements of a cause of action, ‘coupled with a knowledge’ of the others, ‘will commence the [applicable] limitations period.’ [Citation.] Such words do not cast doubt on the sufficiency of suspicion of the elements of a cause of action without knowledge.” (Norgart, supra, 21 Cal.4th at p. 398, fn. 3, italics added.) Thus, Kitzig’s suspicion of negligence by Dr. Nordquist is sufficient to meet the test.

Kitzig’s record citation does not support her claim that Dr. Nordquist told her “everything was okay” after her visit with Dr. Nishimura. The testimony she cites is her husband’s testimony as to what Dr. Simpson told them when they inquired about the fit and appearance of her denture. Kitzig’s husband did testify that up to the time they returned to Dr. Nordquist after the UCLA visit, he never told them anything was wrong, that “[everything is fine, as far as we were concerned.”

Specifically, by the time Kitzig visited Dr. Nishimura, Dr. Nordquist had implemented the negligent treatment plan using artificial bone material; Kitzig had suffered breathing problems caused by infections stemming from her October 1992 surgery (maj. opn., ante, at p. 1388); she had implants fail and enter her sinus; and she was experiencing repeated problems from the opening in her sinus. Dr. Berger testified that Kitzig had “problems from day one” stemming from Dr. Nordquist’s incorrect diagnosis and negligence, including “implants into sinuses; perforations into sinuses; sinus infections; infected implants; [and] lost implants.”