Court Opinion

ID: 9486952
Source: CourtListenerOpinion
Date Created: 2023-08-05 12:04:36.92621+00
Date Added: 2024-06-11T17:52:01.685272
License: Public Domain

RICHARD S. ARNOLD, Chief Judge,
dissenting.
The Court holds that, because Ms. Roth failed to investigate diligently the link between the Cu-7 IUD and her injuries, summary judgment is appropriate. This holding fails to take into account that there is a disputed issue of fact as to whether Ms. Roth should have been on notice that her injuries were potentially caused by the IUD. In the summary-judgment context we must view such disputed issues of fact in the light most favorable to the non-movant, giving her the benefit of all reasonable inferences. I believe the Court departs from this principle, and I respectfully dissent.
I.
The Court holds that Iowa’s two-year statute of limitations bars Ms. Roth’s claims because she could have discovered her cause of action earlier with the exercise of reasonable care. See Franzen v. Deere & Co., 377 N.W.2d 660, 662 (Iowa 1985). The Court *1310points to the patient brochure Ms. Roth read, as well as to the clues she received from the various treating doctors, in holding that she was on notice as to the cause of her injuries.
First, the Court declines to consider Ms. Roth’s assertion that the only warnings she received related to the risk of sexually transmitted diseases and did not concern the non-sexually-transmitted infection she ultimately developed.6 In declining to address this argument, the Court relies on the fact that Ms. Roth failed to raise this precise issue before the District Court. This holding reflects an unduly strict procedural approach. It picks out a subsidiary issue and unnecessarily bars its discussion.
Under Local Rule 14(h), S.D.Iowa, the District Court requires that parties attach a statement of material fact to their papers supporting and opposing summary judgment.7 In her Statement of Material Facts, Ms. Roth stated that she did not remember being given any warnings by Dr. Kuncaitis other than that she might experience an allergic reaction or that there was a risk of a spontaneous abortion; she did not remember being warned about PID. Searle argued in its Statement that Dr. Kuncaitis informed Ms. Roth of the risk of infection, citing the doctor’s deposition testimony. In his deposition, Dr. Kuncaitis stated that he was certain that he gave Ms. Roth the “common warnings,” meaning that the type of behavior that would increase her risk of developing a sexually-transmitted disease — multiple sexual partners, for example — would also increase her risk of getting Pelvic Inflammatory Disease (PID). When Dr. Kuncaitis was expressly asked whether he warned Ms. Roth of the risk of PID, he replied, “Yes. As far as I knew.[8] Not — at that point the way I advised her she did not have an increased risk of developing gonorrhea, but if she did get it, it would markedly increase the rate of spread from the cervix to the upper gynecologic structures.” (Kuncaitis Dep. p. 199, App. 91). Although Dr. Kuncaitis stated that he warned Ms. Roth of the risk of contracting PID, he also emphasized the risk of sexually-transmitted diseases, and later stated that had he known the full side-effects of the Cu-7, he would not have inserted it in the first place. Id. at 141.
By arguing that she did not recall being informed of the risk of PID, Ms. Roth placed at issue the caliber of warnings she received. On appeal, she merely asserts a different interpretation of the very deposition testimony upon which Searle relies. The mere fact that Ms. Roth chose not to emphasize her interpretation of this testimony in the District Court does not mean that she is barred from doing so now. See, e.g., Elder v. Holloway, — U.S. —, 114 S.Ct. 1019, 127 L.Ed.2d 344 (1994). Elder was a § 1983 case where the issue was whether the right was clearly established; neither party cited United States v. Al-Azzawy, 784 F.2d 890 (9th Cir.1985), cert. denied, 476 U.S. 1144, 106 S.Ct. 2255, 90 L.Ed.2d 700 (1986), which was in point. The Court of Appeals affirmed on the basis that the parties did not raise the case below and had thereby failed to establish it as a legal fact. Id. — U.S. at —, 114 S.Ct. at 1022. The Supreme Court reversed the Court of Appeals on the grounds that whether the right was clearly established was a question of law reviewed de novo on appeal. Id. at —, 114 S.Ct. 1023. Similarly, whether there is a material issue of fact with respect to what warnings Dr. Kuncaitis gave Ms. Roth is a question of law to be resolved de novo by this Court. The District Court had Dr. Kuncaitis’s deposition before it, and the question of precisely what he said is included within the question of *1311what warnings Ms. Roth received, an issue squarely presented to the District Court. Therefore, “sandbagging” at the appellate level is not a legitimate concern in this case.
Moreover, in Stafford v. Ford Motor Company, 790 F.2d 702, 706 (8th Cir.1986), a decision relied upon by the Court, the plaintiff argued for the first time on appeal that he had exhausted his internal union appeals procedures under section 2(b) of the UAW Constitution. After stating our general requirement that all issues must be brought first before the District Court, we noted that it is within the authority of this Court to rule on an issue not passed on below when “injustice might otherwise result” and proceeded to reverse and remand for consideration of the plaintiffs new argument. In the present case, declining to address a subsidiary issue that was squarely presented by the proffered deposition testimony would be unjust, especially in light of Ms. Roth’s general challenge to the adequacy of the warnings she received as contained in her Statement of Material Facts.9
Second, in my view, the brochure received by Ms. Roth was neither specific enough nor sufficiently germane to Ms. Roth’s situation to put her on notice as a matter of law.10 The brochure does cite the risk of pelvic inflammation as one of the potential side effects of IUD use; however, it goes on to minimize that risk with respect to women with Ms. Roth’s characteristics.11 The brochure states that the increased risk of pelvic inflammation is “unconfirmed” and “appears to be greatest for young women who have never had a baby and/or who have many sexual partners.” Because Ms. Roth had had a baby and had only one sexual partner, her future husband, Garland Roth, this warning did not adequately address the risk faced by women like Ms. Roth who did not fit into these categories. According to Searle’s own internal memoranda, IUDs enhance the risk of contracting PID. See, e.g., PX. 18. Indeed, Searle had deliberately tailored the brochure’s language to minimize the appearance of risk to women such as Ms. Roth and had actually removed a section called “ADVERSE REACTIONS” which specifically warned of salpingitis and tubal damage or occlusion.12 Although much of the informa*1312tion was still contained in the brochure, it was worded in such a way as to minimize potential problems and to make them seem as innocuous as possible.
Perhaps as important as the less-than-complete warnings in the Searle brochure is the fact that Ms. Roth’s doctor, Dr. Kuneai-tis, had no understanding of the actual side-effects of the Cu-7. Dr. Kuncaitis testified at his deposition that he did not understand that the IUD could cause such seriously damaging infections or that the IUD increased the risk of PID three to five fold. Kuncaitis Dep. 141. Had he understood these facts, he stated, he never would have prescribed the first IUD for Kimberly Roth, and, therefore, we can infer that he would not have prescribed the second. Id. at 142. In looking at these statements in the summary-judgment context, we take them as true, along with all reasonable inferences.
If Dr. Kuncaitis would not have prescribed the IUD for Ms. Roth had he understood the nature of the side-effects, it stands to reason that he was unable to warn Ms. Roth fully. A doctor cannot warn of dangers of which he is unaware. Furthermore, Dr. Kuncaitis stated that he did not remember the precise warnings he gave Ms. Roth (Kuncaitis Dep. 198-200, 73), but assumed that he had given her the “common” warnings. The content of the “common” warnings is uncertain, but it seems likely that they did not fully apprise Ms. Roth of the risk she faced. Additionally, the fact that Dr. Kuncaitis inserted another IUD in Ms. Roth despite the first infection could easily have lead Ms. Roth to believe that the IUD was not the cause of her problems, thus coloring her subsequent dealings with her doctors. That Dr. Kuncaitis thought it was all right to insert a second IUD could explain, in part, why Ms. Roth failed to make the connection between the IUD and her infections before 1988. Finally, Ms. Roth was specifically told by her doctors that the first IUD was removed because it had shifted and was lodged in the uterus. Roth Dep. 117. This is also the explanation she was given for the pain she was experiencing. Id.
Third, the Court relies on Ms. Roth’s failure to ask her doctors whether the IUD had caused her infection in its finding that she failed to conduct a reasonably diligent investigation. The Court specifically points to the warnings in the patient brochure and to the comment made by Dr. Carney as putting Ms. Roth on notice that she should investigate the link between the IUD and her infections.13 The Court further states that since Dr. Beatty would have told her in 1986 that the infection was IUD-associated, meaning that it occurred while the IUD was inserted, her cause of action accrued, at the latest, that year.
The Court fails to mention several key facts in reaching this conclusion. First, as discussed above, the brochure did not give a full and accurate picture of the threat Ms. Roth faced; Dr. Kuncaitis’s lack of understanding only made this deficiency worse. Second, Ms. Roth stated in her deposition that she asked the doctors why she was having recurring infections and what was causing them. The doctors continually told her that they did not know the source and merely continued to treat the infections with antibiotics. Roth Dep. 117, 145, 177-78. Third, Ms. Roth stated in her deposition that she had been told that she had an ovarian cyst. Since the pain she was experiencing was focused around her reproductive organs, she reasonably believed this explanation to be accurate. She was never told otherwise and continued to believe that a cyst was the cause of her problems. Roth Dep. 118, 138, 146-47. Fourth, Dr. Carney’s comment that *1313she should never have had the second IUD inserted is far from unambiguous. On the one hand, it could be saying, as the Court asserts, that the IUD was a potential cause; however, this comment could also mean that it was a mistake to insert the second one, given her previous infections. Additionally, at the time, Ms. Roth ascribed no particular significance to the comment because she still thought the problem was related to her ovaries. Roth Dep. 146. After the comment, Dr. Carney immediately left the room, giving Ms. Roth little opportunity to pursue the issue with him.14 Fifth, she was in a great deal of pain and put her health in the doctors’ hands. The doctors, for their part, did not tell her the nature of her infection, much less its cause. She was not given to understand that the IUD was the cause of her infections; she understood the first IUD had been removed because it had shifted and was given no explanation for the removal of the second IUD. Roth Dep. 146. Finally, by the time she met with Dr. Beatty in 1986 to discuss her options with regard to having more children, she had come to the conclusion that the doctors did not know what the source of the infections was or why she was continuing to have them, and that she had an ovarian cyst that was somehow causing her problem. Ms. Roth did not go to see Dr. Beatty until over two years after removal of her second IUD, and Dr. Beatty appears to have been the first doctor to diagnose Ms. Roth’s chronic PID. See Beatty Dep. 65 and Kuncaitis Dep. 58-59. Whether by that point in time it was unreasonable, given her past experiences, for Ms. Roth not to ask Dr. Beatty about the cause of her infections is not clear as a matter of law. Rather, it is a question for the finder of fact whether facts existed in 1986 that were sufficient to put Ms. Roth on notice of her claims.
Not only is it unclear that Ms. Roth should have been on notice that she needed to conduct a more diligent investigation, it is uncertain what she would have learned had she asked Drs. Carney and Beatty. There is nothing in Dr. Carney’s medical report to demonstrate what Dr. Carney would have said had Ms. Roth asked for clarification. See PX. 13. She in fact did ask both Dr. Kuncaitis and Dr. Wilson what was causing her problems but to no avail. Roth Dep. 144. In her deposition, Dr. Beatty stated that she would have told Ms. Roth that the infection was IUD-associated if asked, but specifically noted that she was saying only that the infection occurred while the IUD was in situ. She would not state, and in fact could not state at that time, that the infection was caused by the IUD itself. Beatty Dep. 26-27. Whether Dr. Beatty’s statements alone would have been sufficient to put Ms. Roth on notice of her claim is questionable, given Dr. Beatty’s hesitancy to point out the IUD as the source of the problem. Nonetheless, even if Dr. Beatty’s answers would have been sufficient, Ms. Roth’s failure to ask may have been reasonable, as previously discussed.15
II.
Under Iowa law, the statute of limitations can be tolled on one of two theories, fraudulent concealment or equitable estoppel. The Roths assert that both of these theories apply to Ms. Roth’s situation, a position the Court rejects. The Roths first argue that Searle’s fraudulent concealment of facts surrounding the relationship between the Cu-7 *1314and PID tolls the statute of limitation. The Iowa courts recognize that statutes of limitation may be tolled if a cause of action is fraudulently concealed by the defendant. In order to avail herself of this doctrine, however, Ms. Roth must have conducted a diligent investigation to discover her cause of action. Pride v. Peterson, 173 N.W.2d 549, 555 (Iowa 1970).
The Court concedes that, if one reads the facts in the light most favorable to the Roths, there is some evidence that Searle attempted to suppress the relationship of the Cu-7 to PID and infertility. Ante at 1308. The Court goes on to cite evidence to the contrary — the previously discussed brochure, as well as the fact that some of the doctors may have been aware of the link in 1984 and 1986 — but assumes for the sake of discussion that the evidence meets the first element of fraudulent concealment. In fact, the evidence indicates that Searle had “retained unto itself the unpermitted option” of filtering toxicity data which the FDA considered to be relevant. See, e.g., PX. 40. In addition, one of the doctors who participated in Searle’s clinical studies was critical of Searle’s research methods and suggested that, contrary to Searle’s flat assertion that infection rates were below 1%, see PX. 17, the methodology was so flawed that it was impossible “to really come out with accurate and true estimates of the incidence of infection.” See Sweet Dep. 797, PX. 28. He further indicated cases that were clearly PID were miscategorized in the final Searle study. Id. at 783-96. The brochure, as discussed previously, is a pale reflection of the risk, arguably insufficient to counter the misinformation Searle fed to doctors and, by extension, to patients. Ultimately, however, the Court fails to note that if the evidence could be sufficient to support the first requirement for a claim of fraudulent concealment, then the summary-judgment standard is met. It is not important to our analysis here whether Ms. Roth has established fraudulent concealment to the satisfaction of this panel.
The Court rejects Ms. Roth’s fraudulent-concealment claim because it holds that she failed to meet the second part of the test, that is, she did not conduct a reasonably diligent investigation into her cause of action. In so holding, the Court points to the same facts surrounding its determination of when the cause of action accrued, that is, Ms. Roth’s failure to ask her doctors. As discussed previously, Ms. Roth did, in fact, ask her doctors what the cause of her problem was and was given no information that would lead her to connect her infections to the IUD. Additionally, the record contains documents and internal Searle memoranda that demonstrate that Searle provided doctors and the FDA with incomplete information concerning toxicity and the connection between the Cu-7 and PID, so what Ms. Roth would have learned had she continued to ask is far from clear. See PX. 40, and Sweet Dep. 783-96; compare PX. 17 with PX. 18.
In Kociemba v. G.D. Searle & Co., 680 F.Supp. 1293 (D.Minn.1988), the District Court for the District of Minnesota faced the same question on similar facts. In Kociem-ba, the plaintiff was fitted with a Cu-7 IUD. She contracted PID and had the IUD removed, but was, nonetheless, rendered infertile by the disease. Like Ms. Roth, Ms. Kociemba saw several doctors in an attempt to uncover why she could not have children; she was told, ultimately, that her fallopian tubes were blocked. However, unlike Ms. Roth, she asked none of the doctors why she was infertile or what was causing her infections. It was not until five years later, when she met with a Dr. Kreider, that Ms. Ko-ciemba discovered a connection between her infertility and the IUD, and then only because Dr. Kreider explicitly told her there might be. In holding that there was a material issue of fact as to whether Searle fraudulently concealed Ms. Kociemba’s cause of action, the District Court pointed to the extensive evidence supporting allegations that Searle concealed information. Id. at 1302. The Kociemba Court’s decision to deny Searle’s summary-judgment motion reflects a well-reasoned determination that a material issue of fact exists with respect to Searle’s fraud.16 In the present case, Ms. Roth did *1315ask her doctors what was causing her infections early on in her treatment, but was given no information. She claims she learned of the connection from a CNN broadcast. Like Ms. Kociemba, it was not until the connection was pointed out to her that she understood that she might have a cause of action.
A jury could find that Searle deliberately concealed information connecting the Cu-7 to PID, and that Ms. Roth conducted a diligent investigation of the facts surrounding her cause of action. Therefore, she has made the threshold showing necessary to withstand Searle’s motion for summary judgment on the issue of fraudulent concealment.
The Court also rejects the Roths’ equitable-estoppel claim: it holds, first, that Iowa law requires that misrepresentations be designed to lead the plaintiff into the “trap of the time bar”; second, that the Roths failed to demonstrate that Searle had this result as its goal when it made its misrepresentations; and third, that the record “contains evidence sufficient to raise substantial doubts” as to whether the Roths knew of the link between the Cu-7 and Ms. Roth’s infections, which knowledge would damage her claim of fraud. Ante at 1309. In finding that Iowa law requires a specific misrepresentation designed to lead the plaintiff into sitting on her rights, the Court relies on Meier v. Alfa-Laval, Inc., 454 N.W.2d 576 (Iowa 1990). However, the tenet that equitable estoppel is not available unless the misrepresentation was intended to lead the plaintiff into the “trap of the time bar,” is taken out of the context that prompted the Meier Court to adopt it.
In Meier, the issue was whether a repair, coupled with verbal assurances that the repair had fixed the problem, could be misrepresentation sufficient to meet the first of the equitable-estoppel requirements. The Iowa Supreme Court dubbed this argument “repair estoppel” and addressed it as an “offshoot” of the general doctrine of equitable estoppel. After discussing the various positions taken by other courts on the issue of when a poorly done repair equals misrepresentation, the Iowa Court decided upon the narrow test referred to by this Court today. The Iowa Court looked to its own policy in originally adopting the doctrine of equitable estoppel and stated that repairs do not rise to the level of deception even when accompanied by assertions that they will cure the defect. Because of this determination, it is insufficient under Iowa law to show that the repair failed to solve the problem. Given the context of the Meier decision, I do not believe the Iowa Supreme Court would extend such a narrow view of the availability of the equitable-estoppel doctrine across the board.
Even if the Court is correct that Iowa law would require a specific showing that the misrepresentations were designed to trick the plaintiff into sitting on her rights, the Roths do not claim, contrary to the Court’s assertion, ante at 1309, that “virtually any false representation or concealment of facts relevant to the ease satisfies” the fraud element of an estoppel claim. The Roths assert, specifically, that Searle concealed from Ms. Roth and her doctors the fact “that non-sexually transmitted pelvic inflammatory infections were a significant side effect of use of the Cu-7.” Brief for Appellants 20. The Roths allege that Searle intended doctors and patients to rely on false information supplied by Searle because so long as they did, “Searle would be safe from suit and from liability for its defective products.” Id. The Roths clearly claim that Searle’s misrepresentations were designed to avoid having to defend a lawsuit based on injuries caused by the Cu-7. For all intents and purposes, this is the same as alleging that Searle wanted to “trap” the Roths with a time bar. There is evidence that Searle misled doctors and patients with the express purpose of obfuscating the connection between PID and the Cu-7. Whether Searle’s misrepresentation should be sufficient to support a claim of equitable estoppel, and whether Ms. Roth relied on those misrepresentations to her detriment, are issues of fact best left to a jury to determine.
III.
Several issues of material fact exist as to what Ms. Roth knew, as well as to when she *1316either knew or should have known it. It is far from clear from the record that Ms. Roth should have continued to ask her doctors about the cause of her infections and infertility, given the lack of information she received from her doctors even when she did ask. Ms. Roth was given an alternate source of her injuries, an ovarian cyst, that she believed to be the cause of her problem until she saw the CNN newscast in 1988. Because it is not clear that Ms. Roth should have been on notice of her claims in 1986,1 think there is an issue of material fact as to whether the statute of limitations is tolled by Searle’s fraud. Finally, there is an issue of material fact as to the purpose and result of Searle’s misrepresentations with respect to the Cu-7.
This case should go to trial.

. The Court refers to the non-sexually-transmitted infection Ms. Roth developed as "allegedf].” Ante, at 1307. That Ms. Roth had a non-sexually transmitted infection is not contested.

. Rule 14(h) reads as follows:
Upon filing any motion for summary judgment ..., there shall be filed with the motion a separate, short, and concise statement of the material facts as to which the moving party contends there is no genuine issue to be tried....
The papers opposing a motion for summary judgment shall include a separate, short and concise statement of the material facts as to which it is contended that there exists a genuine issue to be tried....

. This comment is particularly significant given that Dr. Kuncaitis did not completely understand the side-effects of the Cu-7, as discussed later.

. The cases upon which the Court relies in refusing to consider Ms. Roth’s argument are inappo-site. In Diercks v. Durham, 959 F.2d 710, 713-14 (8th Cir.1992), the defendant-supervisor had argued in the District Court that the plaintiff-prisoner’s admission of guilt obviated the risk of arbitrary decisionmaking. On appeal, she requested, for the first time, a reduction in the damage amount, alleging that the admission had severed the causal connection. In Clarke v. Bowen, 843 F.2d 271, 273 (8th Cir.1988), the petitioner argued for the first time on appeal that the denial of social-security benefits exceeded the scope of the District Court’s prior remand order. Both of these cases involved completely separate issues of fact and law, as opposed to the subsidiary issue rejected by the Court today.

. The Court quotes the brochure's language, ante at 1305, n. 2.

. Ms. Roth argues on appeal that the brochure she received may not be the one Searle showed her during her deposition. Searle did release more than one patient brochure during the period it marketed the Cu-7; earlier brochures did not contain a warning of pelvic inflammatoiy disease, but later brochures did. Although Searle has not conclusively demonstrated that Ms. Roth received this particular brochure, since Ms. Roth did not challenge this assertion in her Statement of Material Facts as required by the District Court, I will assume, as does the Court, that the brochure she received was this one. I do note, however, that if Ms. Roth did not receive this particular brochure, the case for reversal is even stronger.

.The original warning proposed by Searle’s medical staff read as follows:
Pelvic infection: A three to five fold increased risk of pelvic inflammatory disease associated with the use of IUDs has been reported. This risk appears to be greatest for women who are nulliparous, who are under the age of 25, or who have had a multiplicity of sexual partners ....

ADVERSE REACTIONS

Pelvic infection has been reported and may result in future infertility ... ADD TO LIST: Salpingitis, tubal damage or occlusion, fever.
(PX. 38, App. 306). After the warning was edited, it read:
Pelvic infections have been reported following insertion of a Cu-7.... Most infections can be eliminated by antibiotic therapy, but if not, the Cu-7 should be removed.
An increased risk of pelvic infection associated with the use of IUDs has been reported. While unconfirmed, this risk appears to be greatest for young women who have never had a baby and/or who have many sexual partners.... Pelvic infection ... could decrease future chances of getting pregnant or even prevent it. *1312Ms. Roth was under 25 when her IUD was inserted and was, therefore, greatly at risk of contracting PID because of her IUD use. However, Searle removed the portion of the warning that would have made this clear to her. Additionally, whatever her past circumstances, Ms. Roth was monogamous at the time the IUD was inserted and at all other times relevant to this litigation; therefore, the change from the past tense rendered the multiple-sexual-partners warning irrelevant to her. Finally, Searle removed a specific warning that salpingitis, or inflammation of the fallopian tube, a condition Ms. Roth ultimately developed, can result from IUD use and the resultant PID.

. Dr. Carney stated, according to Ms. Roth, that she never should have had the second IUD inserted. Roth Dep. 133.

. Dr. Camey was the doctor in the emergency room at Grinnell Hospital. He and Dr. Kuncai-tis had an arrangement to care for one another's patients when the other was out of town. Ms. Roth's only contact with Dr. Camey was at Grin-nell; she never spoke with him again. However, she did ask Dr. Kuncaitis why she was continuing to have infections, and he was unable to tell her the cause. Roth Dep. 144.

. The District Court and this Court both note as an undisputed fact that there was a great deal of publicity surrounding the Cu-7 and Searle’s removal of the IUD from the market during the mid-1980s. However, the fact of publicity is irrelevant if Ms. Roth was unaware of it. She stated in her deposition that she did not read women’s magazines and that she had not seen any news reports or read any news articles about the Cu-7 controversy until she saw the CNN news story in 1988. Roth Dep. 185. In addition, none of the newspaper clippings presented to this Court or to the District Court appeared in Iowa newspapers. It is entirely possible that Ms. Roth never saw an article on the Cu-7 controversy until 1988. Finally, I note that many of the articles in the record, unlike the CNN stoiy that prompted this suit, did not describe symptoms with any specificity.

. In light of the Court’s apparent disbelief that a case can be made for fraudulent concealment under these circumstances, we note that the jury *1315in Kociemba found against Searle on fraudulent concealment grounds. See PX. 43.