Opinion
No. 5-580 / 04-1536
Filed August 31, 2005
Appeal from the Iowa District Court for Lee (North) County, Mary Ann Brown, Judge.
In this medical malpractice action, plaintiffs appeal an adverse summary judgment, which concluded their case was time-barred. REVERSED AND REMANDED.
James P. Hayes and Karen A. Lorenzen of Hayes Lorenzen Lawyers, P.L.C., Iowa City, for appellants.
Susanna Brown of Rouwenhorst Brown, P.C., West Des Moines, for appellees.
Considered by Zimmer, P.J., and Hecht and Vaitheswaran, JJ.
On December 18, 2002, Jill Marshall-Lucas and her family sued Robert Goodwill, M.D., Fort Madison Family Physicians, and Fort Madison Community Hospital, alleging injuries caused by Dr. Goodwill's malpractice. The district court granted the defendants' motion for summary judgment, concluding the suit was filed outside of the limitations period in Iowa Code section 614.1(9) (2001). From this judgment the plaintiffs appeal. After reviewing the record and considering the arguments presented, we conclude the defendants are not entitled to summary judgment on the present record. We reverse and remand.
I. Background.
We recite this factual background in a light most favorable to the plaintiffs.
On January 10, 1999, Marshall-Lucas saw Dr. Goodwill for treatment of a severe rash. He admitted her to the Fort Madison Community Hospital and prescribed sixty milligrams of Solu-Medrol (a steroid), to be administered intravenously every six hours.
On January 11 a dermatologist from the University of Iowa recommended to Dr. Goodwill that he taper the Solu-Medrol and add other medications. The next day, Dr. Goodwill doubled the dosage of Solu-Medrol. On January 15 he changed her medication from Solu-Medrol to sixty milligrams of Prednisone, to be taken orally once a day. That day, Marshall-Lucas received a dose of the Solu-Medrol at 4:00 a.m., the Prednisone at 8:00 a.m., and another dose of the Solu-Medrol at 10:00 a.m.
Marshall-Lucas was discharged on January 18, 1999. She was ordered to continue the Prednisone. She was unable to obtain the Prednisone on the day of her discharge and informed the nursing staff. She alleges that nobody warned her about any dangers of missing a dose of Prednisone.
The next day, Marshall-Lucas returned to the Fort Madison Community Hospital, with complaints of joint pain. A physician noted that he believed the source of her pain was stopping the Prednisone. He recommended that she resume the Prednisone.
In June 2000 Marshall-Lucas fell. She sought treatment from Dr. Goodwill, who gave her a knee brace. That month, she was also seen at the University of Iowa Hospitals and Clinics, where she was diagnosed with fibromyalgia.
On November 30, 2000, Marshall-Lucas had an MRI done by Dr. Mitchell H. Paul after noting increasing pain in her right knee. The report listed her complaints as "right knee pain. Patient fell six months ago." The MRI revealed bony infarcts and a possible degenerative medial meniscal tear.
The medial meniscus is cartilage in the knee. Taber's Cyclopedic Medical Dictionary 1190 (18th ed. 1997) [hereinafter Taber's].
On December 6, 2000, Marshall-Lucas saw Dr. Paul. His office notes describe the bone infarcts as "benign." He also states, "I do not think she has avascular necrosis at this time. . . ." He further noted, "She definitely has multiple musculoskeletal problems consistent with fibromyalgia. . . ." He recommended an arthroscopy due to "severe symptoms she's having particularly along the medial joint line."
Avascular necrosis, also known as osteonecrosis when it involves bone, is associated with an interference with blood supply, which causes tissue death. See, e.g., Zuccolo v. Blazar, 694 A.2d 717, 718 (R.I. 1997); Dorland's Illustrated Medical Dictionary 1103 (28th ed. 1994); Taber's at 1367.
In Zuccolo, 694 A.2d at 719-20, the Rhode Island Supreme Court concluded that a person who had received steroids was placed on inquiry notice of his avascular necrosis on the date that an MRI revealed the condition. This case is distinguishable for two reasons: first, Marshall-Lucas's avascular necrosis was not diagnosed until after her MRI, and second, Marshall-Lucas's medical history was significantly more complex than Mr. Zuccolo's.
On December 8, 2000, Marshall-Lucas had a preoperative visit, the report from which was signed by Dr. Paul and a nurse from the Fort Madison Community Hospital. Records from that visit indicate a past medical history of right knee avascular necrosis, as well as fibromyalgia and arthritis; however, later in this report Dr. Paul repeated his belief that she did not have avascular necrosis. The diagnostic impression was a medial meniscal tear in the right knee, and the planned operation was to perform an arthroscopy to repair the medial meniscal tear.
On December 18, 2000, Marshall-Lucas had her arthroscopy, which was performed by Dr. Paul. Hospital records from that date indicate a preoperative diagnosis of "medial meniscal tear, right knee"; however, Dr. Paul did not see a meniscal tear. Based on the arthroscopy, Dr. Paul diagnosed her with avascular necrosis. On March 21, 2001, a physician at the University of Iowa Hospitals and Clinics first told Marshall-Lucas of a possible connection between the medication she received in January 1999 and her avascular necrosis.
"[A] connection between avascular necrosis and steroids like Medrol has been documented in the medical literature." Zuccolo, 694 A.2d at 718 (citing Philip N. Sambrook et al., Osteonecrosis After High Dosage, Short Term Corticosteroid Therapy, 11 J. Rheumatology 514 (1984)); see also Taber's at 1367.
Ms. Marshall Lucas and the other plaintiffs filed this suit on December 18, 2002. The defendants answered, asserting the statute of limitations as an affirmative defense. Both parties demanded a jury trial. On March 23, 2004, the defendants deposed Marshall-Lucas. She testified that the pain associated with her avascular necrosis was different than the other pain that she had. She stated the avascular necrosis pain started just before her MRI on November 30, 2000; however, she further indicated that she did not know what kind of pain she was having. At first, she stated that she was told she had avascular necrosis on December 6, 2000; however, after being confronted with Dr. Paul's records from that visit (in which he declined to diagnose her with avascular necrosis), Marshall-Lucas stated she would agree with what Dr. Paul wrote.
On May 7, 2004, the defendants filed a motion for summary judgment, arguing the action was time-barred. To their statement of undisputed material facts, they attached an affidavit from Dr. Paul, in which he stated that he diagnosed Marshall-Lucas with avascular necrosis on December 6, 2000.
The district court granted summary judgment to the defendants. The court concluded "the statute of limitations began to run at least by November 30, 2000." The court further concluded that because the petition was not filed within two years after that date, the matter was time-barred. After the district court overruled their post-trial motion, the plaintiffs appealed.
II. Scope and Standard of Review.
We review the district court's summary disposition of this matter for the correction of errors at law. Iowa R. App. P. 6.4.
We will affirm the district court's summary judgment for the defendants "if the pleadings, depositions, answers to interrogatories, admissions on file, and affidavits show that there is no genuine issue of material fact and that the moving party is entitled to judgment as a matter of law." Ratcliffe v. Graether, 697 N.W.2d 119, 123 (Iowa 2005); see also Iowa R. Civ. P. 1.981. The defendants must prove the nonexistence of a genuine issue of material fact. Vachon v. State, 514 N.W.2d 442, 443 (Iowa 1994). We view the record in a light most favorable to the plaintiffs, as the nonmoving parties. Id. A genuine issue of material fact exists if "reasonable minds could differ as to how a factual issue should be resolved." Id. If reasonable minds could draw different inferences from the undisputed facts, summary judgment is inappropriate. Iowa R. App. P. 6.14(6)( q). However, if the only dispute concerns the legal conclusion to be drawn from undisputed facts, summary judgment is appropriate. Ratcliffe, 697 N.W.2d at 123.
III. Discussion.
Iowa Code section 614.1(9)(a) provides, in relevant part, that an action for medical malpractice must be brought within two years "after the date on which the claimant knew, or through the use of reasonable diligence should have known" of the injury for which recovery is sought. This language codifies the discovery rule.
"Underlying the discovery rule is inquiry notice." Ratcliffe, 697 N.W.2d at 124. "[T]he statute [of limitations] begins to run when a person gains knowledge sufficient to put the person on inquiry." Id. (quoting Langner v. Simpson, 533 N.W.2d 511, 518 (Iowa 1995)). However, not every pain or symptom will put a person on inquiry notice. Cf. Vachon, 514 N.W.2d at 446. Whether a person has been put on inquiry notice will "turn on the circumstances of each case." Id. As noted by an Illinois court, construing a similar statute, "In seeking the date of discovery, we recognize the exact moment of revelation is not always apparent." Paige-Myatt v. Mount Sinai Hosp. Med. Ctr., 729 N.E.2d 908, 914 (Ill.App.Ct. 2000).
The issue in this case is simply stated. Have the defendants proven that all undisputed material facts require a conclusion, as a matter of law, that Marshall-Lucas was placed on inquiry notice more than two years before she filed her suit? After reviewing the unique facts of this case, see Vachon, 514 N.W.2d at 446, we think not. Rather, we conclude reasonable minds may differ as to this point and, for that reason, summary judgment is not proper.
Considering the present record, we believe summary judgment is foreclosed by several factors. First, Marshall-Lucas's medical history is a barrier to summary judgment. We note it is undisputed that several of her co-occurring medical conditions caused pain in her legs. Given her fibromyalgia, arthritis, and recent fall, among other medical conditions, we conclude that reasonable minds could differ as to whether the pain she felt prior to her November 30, 2000, MRI was such that it put her on inquiry notice of her avascular necrosis. Rather, viewing the record in a light most favorable to the plaintiffs, see id. at 443, reasonable minds may arrive at a conclusion that a reasonable person, similarly situated to Marshall-Lucas, would not necessarily be put on inquiry notice.
A reasonable fact-finder could permissibly find, based on the present record when viewed in a light most favorable to Marshall-Lucas, that the pain she experienced was sufficiently similar to the pain caused by her other medical conditions, such that she was not on inquiry of the undiagnosed avascular necrosis, especially since Dr. Paul wrote that she has "multiple musculoskeletal problems consistent with fibromyalgia." Although Marshall-Lucas's pain prior to November 2000 is a factor in considering whether she was on inquiry notice, this factor alone is not dispositive. Finally, the presence of several co-occurring medical conditions that cause similar pain is a crucial fact absent from all of the cases cited by the defendants and the district court. Those cases are distinguishable.
We note that there is evidence in the record that the pain associated with what was eventually diagnosed as avascular necrosis is different than the pain associated with Marshall-Lucas's other conditions. We cannot see that the present record conclusively establishes, as a matter of law, that the pain was sufficiently different from her other pain such that she was placed on inquiry notice. As one court noted in construing a similar statute, patients are not necessarily on inquiry notice if another "facially logical explanation" for their symptoms exists. Webb v. Neuroeducation, Inc., 88 P.3d 417, 420 (Wash.Ct.App. 2004) (citation omitted). Here, a reasonable fact-finder could permissibly conclude that Marshall-Lucas had at least one, if not more, "facially logical explanation" for the pain that later was discovered to be caused by avascular necrosis.
The second factor foreclosing summary judgment is the apparent difficulty with which Marshall-Lucas's avascular necrosis was diagnosed. While the November 30 MRI revealed bony infarcts, which Dr. Paul described as "benign" in his December 6 record, it also revealed what appeared to be a degenerative cartilage tear. Dr. Paul proceeded on this assumption, saying in a note from Marshall-Lucas's December 8 preoperative visit that (1) she did not have avascular necrosis, and (2) she had a medial meniscal tear in her right knee. Only after her December 18 arthroscopy was she diagnosed with avascular necrosis. If medical professionals had such apparent difficulty with this diagnosis, we cannot say, as a matter of law, that a reasonable person in Marshall-Lucas's position, including her multiple medical conditions, would have been put on inquiry notice. Rather, a reasonable fact-finder could permissibly conclude that she was put on inquiry notice only after the arthroscopy revealed avascular necrosis and ruled out other possible causes for her pain. Cf. Artal v. Allen, 3 Cal. Rptr. 3d 458, 464 (Ct.App. 2003) ("As it turned out, the necessary facts could not be ascertained without exploratory surgery.").
Third, we conclude the differences between Marshall-Lucas's medical records and the affidavit of Dr. Paul, along with the ambiguity of Marshall-Lucas's deposition testimony, preclude summary judgment. Defendants asserted in the district court, as an undisputed fact, that Dr. Paul told Marshall-Lucas on December 6, 2000, that she had avascular necrosis. Although the district court did not address this issue, the defendants advance it on appeal as a means of preserving their favorable judgment. After reviewing the record, this is far from undisputed. Rather, we conclude this involves a judgment of witness credibility, which is almost always reserved to the finder of fact. Given the contents of Marshall-Lucas's medical records, it is for the finder of fact to determine whether Dr. Paul was credible when he wrote that he told Marshall-Lucas she had avascular necrosis on December 6, 2000.
On the present record, reasonable minds could differ as to when Marshall-Lucas was put on inquiry notice of her avascular necrosis. The district court's summary judgment in favor of the defendants must be reversed.
IV. Conclusion.
We have considered all issues properly preserved for our review, whether or not discussed in this opinion. We reverse and remand for proceedings consistent with this opinion.