Court Opinion

ID: 9477587
Source: CourtListenerOpinion
Date Created: 2023-08-05 06:26:45.635463+00
Date Added: 2024-06-11T17:45:57.124087
License: Public Domain

NORRIS, Circuit Judge,
dissenting:
This case requires us to decide when a layperson will be deemed to know enough about the cause of a specific medical condition to be on notice that she may have been the victim of tortious conduct by medical personnel. Our precedents establish a clear-sounding rule: An action for medical malpractice under the FTCA accrues when the prospective plaintiff knew or should have known of her injury and its cause. Applying this standard, the majority holds that the statute of limitations started to run when Mrs. Herrera-Diaz was told six months after Victor’s birth that a “lack of oxygen” at or near the time of delivery may have “caused” his cerebral palsy. At 1537.
I agree with the majority that whether Victor Herrera-Diaz’s claim is barred by the statute of limitations depends on when Mrs. Herrera-Diaz discovered, or in the exercise of due diligence should have discovered, both her child’s injury and its cause. I believe, however, that the majority has erred on two critical counts. First, Mrs. Herrera-Diaz’s deposition testimony —upon which the majority exclusively relies — is thoroughly ambiguous about what she was told caused her son’s injury. Her testimony cannot fairly be construed as establishing for the purpose of summary judgment that she knew or should have known the cause of Victor’s cerebral palsy. Second, even if Mrs. Herrera-Diaz knew that a “lack of oxygen” caused Victor’s injury, this bare knowledge of the technical medical cause of Victor's injury did not constitute the kind of “knowledge of cause” which under current case law must exist before the statute of limitations will start to run.
Although the majority suggests that when Victor was six months old Mrs. Herrera-Diaz was told that a lack of oxygen had caused her son’s cerebral palsy, id., her deposition indicates that the information she received was not nearly so definitive.1 Mrs. Herrera-Diaz testified that the staff at the United Cerebral Treatment and Rehabilitation Center told her both that premature babies sometimes develop cerebral palsy and that cerebral palsy can result from a lack of oxygen at the time of delivery. It is entirely unclear from the deposition that the lack of oxygen problem was presented as a separate possible cause of the injury as opposed to simply being a part of the natural physical difficulties at-tendent to prematurity. Indeed, the information that Mrs. Herrera-Diaz received, as related in her deposition, was wholly con*1539sistent with an initial belief that Victor’s injuries were a natural result of his premature delivery. In short, Mrs. Herrera-Diaz’s deposition, when viewed in the light most favorable to her, does not establish that she was put on notice that lack of oxygen was anything other than a function of prematurity.
Even assuming, however, that Mrs. Herrera-Diaz knew or should have known that a lack of oxygen caused Victor’s injury, in my view this is not the sort of “knowledge of cause” sufficient to trigger the statute of limitations. Knowledge of cause, like the definition of cause itself, is a slippery concept. The cause of every medical injury may be described with equal accuracy in a virtually infinite number of ways “embracing everything that has ever occurred commencing with the ultimate cause of causes up until the present instant.” Lee v. United States, 485 F.Supp. 883, 887 (E.D.N.Y.1980). To take a simple hypothetical malpractice case, the cause of a prospective plaintiff’s heart attack might be described variously as 1) the failure of the left ventrical muscle, 2) the failure of the heart muscle in response to an injection of nitroglycerin, or 3) the negligent administration of nitroglycerin by the plaintiff’s physician. Similarly, a prospective plaintiff’s knowledge of cause may range from nothing more than an awareness of the purely medical or scientific explanation for an injury to an informed belief that an injury was caused by actual negligence on the part of an attending doctor.
The majority apparently believes that any kind of knowledge of cause is sufficient to trigger the statute of limitations. Neither case law nor common sense compels such an simplistic definition of knowledge of cause. To trigger the statute of limitations, a prospective plaintiff must have the sort of knowledge of cause that would lead a reasonable person to investigate whether she might have been the victim of malpractice. Although suspicion of negligence is not required before the statute of limitations starts to run, bare knowledge about the mechanical or technical medical cause of injury (failure of the left ventricle muscle) is not sufficient. At a minimum, a prospective plaintiff must be aware that the injury at issue may have occurred as the result of some human act or omission (the injection of nitroglycerin) and was not merely the result of a natural physical defect. In the absence of knowledge that a human agent may have contributed to the injury, a prospective plaintiff simply has no reason to investigate potential legal remedies, and his cause of action should not accrue.
This reading of what knowledge is required to trigger the statute of limitations follows logically from the three cases upon which the majority rests its holding — United States v. Kubrick, 444 U.S. 111, 100 S.Ct. 352, 62 L.Ed.2d 259. (1979), Davis v. United States, 642 F.2d 328 (9th Cir.1981), and Fernandez v. United States, 673 F.2d 269 (9th Cir.1982). In Kubrick, a doctor had injected plaintiff’s infected femur with neomycin. After Kubrick began to suffer from substantial hearing loss, a second doctor informed him that his hearing impairment probably resulted from the neomycin treatment. Kubrick argued and the Court of Appeals held that he should not be deemed to have had sufficient knowledge of cause until he knew or could be reasonably expected to know that the neomycin treatment constituted medical malpractice. The Supreme Court disagreed, holding that it was sufficient to trigger the statute of limitations that Kubrick knew “that he ha[d] been hurt and who ha[d] inflicted the injury.” Kubrick, 444 U.S. at 122, 100 S.Ct. at 359. Armed with these critical facts, Kubrick “need only have made inquiry among doctors with average training and experience in such matters to have discovered that he probably had a good cause of action.” Id. at 122-23, 100 S.Ct. at 359-60. In holding that Kubrick’s claim accrued when he discovered the “cause” of his injury, the Supreme Court plainly was not making reference to the chemical action of neomycin on Kubrick’s body, but rather to the administration of the drug by identifiable hospital personnel. Under Kubrick, the statute of limitations will not start to run until the prospective plaintiff “can protect himself by seeking advice in *1540the medical and legal community.” Id. at 123, 100 S.Ct. at 360. Without knowledge of the human participation in the causation of his injury, Kubrick could enjoy no such protection.
Our circuit’s decision in Davis, following Kubrick, also rests on the fact that the plaintiff had sufficient knowledge of the human cause of his injury to inquire about possible negligence. In Davis, the plaintiff had contracted polio after receiving the Sabin vaccine. We held that Davis’s action accrued after he knew that he had contracted polio and that the Sabin vaccine had caused his injury. Our court rejected Davis’s argument that the action should not accrue until he had reason to believe that the United States had been negligent in approving the particular batch of the vaccine from which he had been immunized. As in Kubrick, the plaintiff in Davis clearly was armed with the critical facts about his injury and could reasonably be expected to inquire about whether and whom to sue. Davis, 642 F.2d at 331.
Fernandez, upon which the majority places special emphasis, similarly applies the Kubrick analysis. On the third day of his life, Mark Fernandez, a prematurely born infant, was discovered to have developed jaundice. His doctors then embarked on an elaborate course of testing and treatment including several blood transfusions. Mark’s condition ultimately stabilized and he was released from the hospital at which time Mark’s parents were given a summary of his treatment for jaundice. Within the first 2V2 years of his life, Mark developed a variety of physical and mental impairments which his mother explicitly recognized as having been caused by the jaundice. Fernandez, 673 F.2d at 270-71.
Over 12 years later, the Fernandez filed suit under the FTCA. In ruling that the statute of limitations barred the Fernandez' claim, we noted that for at least twelve years Mark’s parents knew or had the means of knowing “all there was to know about the cause of his injuries, and who (the nurses and doctors who diagnosed and treated his jaundice) were responsible.” Fernandez, 673 F.2d at 271. Following Kubrick and Davis, “we decline[d] to defer accrual of the claim until fault, as distinguished from injury and cause, [was] determined.” Id. at 272. And quoting Kubrick, we held that the Fernandez were in “possession of the critical facts that [their son] ha[d] been hurt and who ha[d] inflicted the injury” and could “protect [themselves] by seeking advice in the medical and legal community.” Id. at 271-72.
In sum, Kubrick, Davis, and Fernandez stand for two propositions: first, that suspicion of negligence is not required before the statute of limitations starts to run; and second, that the statute of limitations will not run until a prospective plaintiff is in possession “of the critical facts that he has been hurt and who has inflicted the injury.” Absent this sort of knowledge of cause, a prospective plaintiff simply has no notice that he may have a valid lawsuit. See Lee, 485 F.Supp. at 887 (“In an action for medical negligence the ‘cause’ which is at issue is the act of the defendant which gave rise to the injury”).
Mrs. Herrera-Diaz, as distinguished from the plaintiffs in Kubrick, Davis and Fernandez, simply was not in command, nor should she have been in command, of sufficient knowledge about the cause of her son’s injury to prompt an inquiry into potential malpractice. Nothing that she was told by various medical personnel, including the fact that cerebral palsy may be caused by a lack of oxygen at birth, ever alerted her to the possibility that her doctors, by either act or omission, might have been negligent in handling Victor’s birth. In my view, a layperson might reasonably have believed, as Mrs. Herrera-Diaz apparently did, that Victor’s cerebral palsy was fully explicable as the result of a purely natural cause — his serious prematurity. Informing Mrs. Herrera-Diaz that lack of oxygen as well as prematurity can cause cerebral palsy did nothing more than inform her of a possible technical cause of her son’s injury. See Lee, 485 F.Supp. at 887 (parent told that newborn had difficulty breathing, fluid in the lungs and had experienced decreased levels of oxygen to the brain “could reasonably have believed that the condition was wholly unrelated to *1541anything the doctors did”). Discovery of this technical cause simply cannot be deemed sufficient knowledge of cause to trigger the statute of limitations. Without some suggestion that a human agent might have contributed to her son’s injury, Mrs. Herrera-Diaz cannot be faulted for not inquiring further about the cause of Victor’s cerebral palsy. In other words, the record as it now stands fails to establish that Mrs. Herrera-Diaz had sufficient knowledge about who inflicted her son’s injury. Under the Kubrick line of cases such knowledge is a prerequisite to the triggering of the statute of limitations.
I dissent.

. The relevant part of Mrs. Herrera-Diaz’s deposition reads as follows:
Q But Dr. Quinn or doctors at the United Cerebral Treatment and Rehabilitative Center in Roosevelt, Long Island, they told you that premature babies sometimes develop cerebal palsy?
A Yes.
Q And did she also tell you that cerebral palsy can be caused by a lack of oxygen during the baby’s delivery?
A To the brain. A lack of oxygen to the brain. And it can come from delivery, she said. And that was that.
Q Did she tell you it might come from some other time than delivery?
A No.
Q Do you understand my question?
A I understand what you are saying. No, I really do not remember her exact words, you know. She was just trying to tell me how children with C.P. get it.
Q Now, did Dr. Quinn ever tell you what might have caused this cerebral palsy?
A No.
Q Did you ever ask her what she thought caused it?
A No.
Q Did you have any idea at that point how cerebral palsy happens to a child?
A No, till she told me. She told me that premature babies it happens to. And a lack of oxygen. And that’s it.
Q Lack of oxygen? What does lack of oxygen mean? ■
A That’s what she said, lack of oxygen.
Q What does that mean to you, lack of oxygen? When or where?
A Delivery. When I found out he had that, I just thought it was because there was — it was meant for him to be like this....