Court Opinion

ID: 9647413
Source: CourtListenerOpinion
Date Created: 2023-08-23 13:35:40.575881+00
Date Added: 2024-06-11T15:02:37.098029
License: Public Domain

HECHT, Justice,
dissenting.
When Mrs. Conaway asked Dr. Chambers whether the lump in her breast was cancerous, he diagnosed, correctly, that it was not. She continued to see him for entirely unrelated problems. She never mentioned another problem with her breast, and he never inquired. Much later, another lump was cancerous. Mrs. Conaway claims that as long as she continued to see Dr. Chambers, regardless of the reason, he should have asked her about lumps in her breasts and checked her for cancer. The Court agrees. The rule the Court announces today is that if a physician correctly diagnoses a patient not to have a disease or condition, but continues to treat the patient for entirely unrelated matters without cheeking for the disease or condition the patient has never had, an action for failure to diagnose the disease or condition is never barred by limitations. In other words, if a patient can have a disease but doesn’t, and continues to see the same physician, limitations never bars a claim for failure to diagnose the disease. I dissent.
According to the Medical Liability and Insurance Improvement Act, limitations begins to run on a health care liability claim either “from the occurrence of the breach or tort or from the date the medical or health care treatment that is the subject of the claim or the hospitalization for which the claim is made is completed.” Tex.Rev.Civ.Stat.Ann. art. 4590i, § 10.01 (Vernon Supp.1993). With respect to the second of these dates, the date treatment ends, we held last year in Rowntree v. Hunsucker, 833 S.W.2d 103 (Tex.1992), that when the facts regarding the nature of medical treatment are undisputed, as they were in that case and are in this one, the question of when treatment was completed is one for the court to answer as a matter of law. There we held, as a matter of law, that a single instance of prescription renewal, at least when there is no claim that the medication caused the harm, does not by itself “demonstrate sufficient involvement by the physician to constitute a continuing course of treatment.” Id. at 108.
The Court in the present case acknowledges Rowntree but attempts to circumvent it by focusing on the first date specified in section 10.01, the occurrence of the breach or tort. The Court concludes that Mrs. Cona-way has raised a question of fact whether Dr. Chambers was negligent in his care of her because he failed to treat her for possible breast cancer each time she visited him for “ailments unrelated to the lump in her breast.” Mrs. Conaway does not allege that the purpose of any of these visits was to seek further treatment of the lump or possible cancer. Since some of those visits occurred within two years of the date Mrs. Conaway sued Dr. Chambers, the Court holds that her action cannot be said to be barred by limitations as a matter of law. By basing its analysis on the date of breach or tort, the Court claims to have avoided having to determine whether and when Dr. Chambers ceased to treat Mrs. Conaway for possible breast cancer.
Logic defeats this claim. If Dr. Chambers was negligent in failing to treat Mrs. Cona-way for possible breast cancer each time she saw him, it follows that his treatment of her for the lump and possible breast cancer was continuing. If his treatment of that potential condition ceased, then he could not be negligent for failing to treat that condition simply because he continued to treat Mrs. Conaway for other conditions. It is logically impossible for a physician to be negligent in caring for a condition after his treatment of that condition ceases.
*162Thus, the Court is simply incorrect when it concludes that it need not determine when Dr. Chambers’ treatment of Mrs. Conaway for possible breast cancer ceased. In fact, that determination is inescapable. The logical consequence of the Court’s holding is that Dr. Chambers’ treatment of Mrs. Conaway’s breast condition was never completed. There are, in my view, two difficulties with this result.
The first is that it is directly contrary to one of the principal authorities on which we relied in our unanimous opinion in Rowntree issued just last year: Nykorchuck v. Henriques, 78 N.Y.2d 255, 573 N.Y.S.2d 434, 577 N.E.2d 1026 (1991). That case is so strikingly similar to the present case, I quote from it at length:
Plaintiff first began seeing Dr. Hen-riques in 1974 for infertility problems, which were determined to be secondary to endometriosis. The doctor treated plaintiff for that condition over a period of years, culminating in surgery in April 1982. During an office visit in July 1979, plaintiff brought to the doctor’s attention a lump in her right breast. After examining the breast, he allegedly told plaintiff that the lump was attributable to noncancerous fibrocystic disease and that “we will have to keep an eye on it.” In addition, lumps in both breasts were noted during an examination of plaintiff conducted by an unspecified person upon plaintiffs admission to the hospital for the April 1982 surgery. No further evaluation was performed at that time.
After the surgery, plaintiff saw the doctor three times, the last time in September 1983, for postoperative care and adjustment of estrogen replacement medication. The doctor phoned in renewals of plaintiffs prescriptions in 1984 and in June 1985. In December 1985, plaintiff scheduled an appointment with the doctor because she had detected enlargement of the mass in her right breast. The doctor examined defendant in January 1986 and immediately referred her to an oncologist, who diagnosed breast cancer. This action was commenced in December 1987.
A medical malpractice claim generally accrues on the date of the alleged wrongful act or omission and is governed by a 2½-year Statute of Limitations (Davis v. City of New York, 38 N.Y.2d 257, 259, 379 N.Y.S.2d 721, 342 N.E.2d 516; CPLR 214-a). Under the continuous treatment doctrine exception, however, the 2¡¿-year period does not begin to run until the end of the course of treatment “ “when the course of treatment which includes the wrongful acts or omissions has run continuously and is related to the same original condition or complaint’” (McDermott v. Torre, supra, 56 N.Y.2d [399] at 405, 452 N.Y.S.2d 351, 437 N.E.2d 1108, quoting Borgia v. City of New York, supra, 12 N.Y.2d [151] at 155, 237 N.Y.S.2d 319, 187 N.E.2d 777). The purpose of the doctrine is to “maintain the physician-patient relationship in the belief that the most efficacious medical care will be obtained when the attending physician remains on a case from onset to cure” (McDermott v. Torre, supra, 56 N.Y.2d at 408, 452 N.Y.S.2d 351, 437 N.E.2d 1108). The doctrine rests on the premise that it is in the patient’s best interest that an ongoing course of treatment be continued, rather than interrupted by a lawsuit, because “the doctor not only is in a position to identify and correct his or her malpractice, but is best placed to do so.” (Id.)
Thus, essential to the application of the doctrine is that there has been a course of treatment established with respect to the condition that gives rise to the lawsuit. We have held that neither the mere “continuing relation between physician and patient” nor “the continuing nature of a diagnosis” is sufficient to satisfy the requirements of the doctrine (id., at 405, 406, 452 N.Y.S.2d 351, 437 N.E.2d 1108). In the absence of continuing efforts by a doctor to treat a particular condition, none of the policy reasons underlying the continuous treatment doctrine justify the patient’s delay in bringing suit.
Here, plaintiff has failed to allege facts which would support a finding that a course of treatment was established in connection with her breast condition. The only course of treatment alleged was related to a separate medical condition, endom-*163etriosis. Under the relevant statute and case law, this is not sufficient. CPLR 214— a explicitly requires that, for the toll to apply, the continuous treatment must be “for the same illness, injury or condition which gave rise to the * * * act, omission or failure” complained of (see also, McDermott v. Torre, supra, 56 N.Y.2d at 405, 452 N.Y.S.2d 351, 437 N.E.2d 1108; Borgia v. City of New York, supra, 12 N.Y.2d at 155, 237 N.Y.S.2d 319, 187 N.E.2d 777 [the course of treatment must be “related to the same original condition or complaint”]). No connection between plaintiffs breast condition and the course of treatment for endometriosis has been alleged.
Nor do the isolated breast examinations, only one of which is alleged to have been performed by defendant doctor during the relevant period, establish a course of continuous treatment with respect to plaintiffs breast condition (see, Davis v. City of New York, 38 N.Y.2d 257, 379 N.Y.S.2d 721, 342 N.E.2d 516, supra). In Davis, we held that two diagnostic examinations, conducted a year apart, were “discrete and complete” and did not constitute continuous treatment (38 N.Y.2d, at 260, 379 N.Y.S.2d 721, 342 N.E.2d 516). The examinations in this case were equally “discrete and complete” and were separated by an even greater period of time.
Id. 573 N.Y.S.2d at 435-36, 577 N.E.2d at 1027-1028. Our reference to Nykorchuck in Rowntree was not obscure. Rowntree, 833 S.W.2d at 106. We recited the facts and quoted from the opinion at some length. The Court offers no justification for abandoning the rationale and authority of Rowntree in this case.
The second difficulty with the Court’s result is that it is impractical and inconsistent with the philosophy underlying the statute of limitations. Again, as the New York Court of Appeals explained:
A holding that the continuous treatment doctrine is applicable to these facts would fundamentally extend and alter the doctrine. The gravamen of plaintiffs claim is not that the doctor performed certain negligent acts or omissions during a course of treatment for her breast condition, but rather that the doctor was negligent in failing to establish a course of treatment at all. While the failure to treat a condition may well be negligent, we cannot accept the self-contradictory proposition that the failure to establish a course of treatment is a course of treatment.
Id. 573 N.Y.S.2d at 436-37, 577 N.E.2d at 1028-1029. The same can be said of this case.
In essence, the Court holds that once a physician examines a lump in a patient’s breast, he may be obliged to treat her for that lump whenever she sees him again, no matter what the purpose of her visit. In such a case, limitations never runs.1 I would hold, following Rowntree and Nykorchuck, that under these facts Dr. Chambers’ treatment of Mrs. Conaway’s breast condition ceased the last time she mentioned it to him. Since that was more than two years prior to the date Mrs. Conaway filed suit, I would hold that her suit is barred by limitations. Accordingly, I dissent.

. According to the Court, limitations runs like it always does, but the cause of action accrues over and over. Ante at 158 n. 2. The Court’s attempted distinction is all semantics. It does not change the fact that if a patient is correctly diagnosed not to have a disease or condition and continues to see the physician for unrelated matters, the physician may be liable for not diagnosing the disease or condition if the patient ever does have it, even if the patient never seeks treatment for it again. If a physician is always responsible for diagnosing recurrence of past complaints, even if the patient continues to seek treatment only for completely unreleated matters, why should the physician not also be liable for failing to diagnose problems which might exist, even if the patient does not seek treatment for them? In other words, under the Court’s view, why shouldn’t a physician who is asked to treat a sprained foot also be responsible, in every situation, for checking the patient’s cholesterol, and liable for failing to prevent the patient's eventual heart attack.