Ratcliff v. Graether, 03-1816.

• Decision Date: 10 June 2005
• Docket Number: No. 03-1816.,03-1816.
• Citation: 697 N.W.2d 119
• Parties: Bruce L. RATCLIFF, Appellant, v. John M. GRAETHER and Wolfe Clinic, P.C., Appellees.
• Court: Iowa Supreme Court

697 N.W.2d 119

Bruce L. RATCLIFF, Appellant, v. John M. GRAETHER and Wolfe Clinic, P.C., Appellees.

No. 03-1816.

Supreme Court of Iowa.

May 13, 2005.

Rehearing Denied June 10, 2005.

John W. Holmes of Holmes & Holmes, Waterloo, for appellant.

Robert C. Rouwenhorst of Rouwenhorst & Brown, P.C., West Des Moines, for appellees.

LAVORATO, Chief Justice.

In this medical malpractice action, the plaintiff, Bruce L. Ratcliff, appeals from a district court ruling sustaining a motion for summary judgment filed by the defendants, John M. Graether, M.D. and Wolfe Clinic, P.C. At issue is whether the continuous treatment doctrine tolled the statute of limitations. Because we conclude the doctrine did not toll the statute, we affirm.

I. Background Facts.

Wolfe Clinic, P.C. sponsored an orientation seminar, which Ratcliff attended, that provided information on elective surgery designed to reduce or eliminate the need to wear eyeglasses or contact lenses. At that seminar, Norman F. Woodlief, M.D. of the clinic talked about various surgical techniques that were available, which involved removing tissue from the cornea.

On April 30, 1996, Ratcliff pursued this treatment at which time Graether of the Wolfe Clinic performed surgery on Ratcliff's right eye. That eye had a negative twelve diopters myopia reading prior to surgery.

On April 9, 1997, Graether performed an "enhancement" surgery on the eye. Enhancement surgeries remove additional tissue and further flatten the cornea. Such surgeries are often performed because surgeons choose to err on the side of undercorrection with the first surgery.

Ratcliff described how the enhancement surgery improved his vision:

[F]rom the moment it was uncovered the day following the surgery, the vision was clear and much improved over what I'd had prior to any surgery, and I felt that if I could get vision in my left eye as good as what I was now seeing in the right eye that this would be a benefit.

On April 30 Graether performed LASIK surgery on Ratcliff's left eye, which had a negative ten diopters myopia reading. After this surgery, Ratcliff said his vision was "very clouded" and "terrible" compared to what had happened just less than a month before on the right eye.

On May 13 Graether told Ratcliff he might have overcorrected the left eye. A week later, Graether told Ratcliff that a cataract was forming on that eye, which was not present prior to the surgery. The cataract formation, according to Graether, was just a coincidence.

At some point in 1997, Graether stopped seeing patients in the Wolfe Clinic's Cedar Falls office, where Graether had seen Ratcliff. Graether chose to see patients only in the clinic's Marshalltown office. From that time forward, Todd W. Gothard, M.D. treated Graether's Cedar Falls patients and kept Graether informed of their progress.

On December 23 Ratcliff saw Richard C. Mauer, M.D., an ophthalmologist and ophthalmic surgeon, because of the cataract formation. In his deposition, Ratcliff explained more fully why he saw Mauer and what Mauer told him:

I was still having a great deal of problem with my eye. I, frankly, had doubted their explanation of the cataract as being the cause, and so in the interim I had gone to Dr. Mauer for a second opinion as to the effect of the cataract. And I was told by Dr. Mauer that, yes, there was a very small, tiny cataract forming, but that it would not be perceptible to me at that stage, and he didn't believe that the cataract would account for my visual problems.

....

Q. What did you tell Dr. Mauer? A. Well, to the best of my recollection, the general theme of it was that I had serious visual problems with the left eye and that both Dr. Graether and Dr. Gothard told me it was due to a cataract, and I didn't think the timing made much sense, and I wanted his opinion.

....

Q. What did Dr. Mauer tell you he thought was wrong with your left eye when you saw him in December of 1997? A. He told me that he thought that the surface of my cornea was irregular.

Q. And did he offer an opinion to you that that was probably related to the LASIK surgery that you had had on your left eye? A. I think he was careful not to accuse anybody of anything. But that was clearly the message that I got.

Q. All right. So he made it clear to you that — or at least the impression that you had when you left his office in December of 1997 was that the LASIK procedure that you had had on April 30 of 1997 had caused some irregularity in your cornea; correct? A. Yes, that's correct.

....

Q. So in the December visit of 1997 with Dr. Mauer, you believe that your problem was vision in your left eye related to an irregularity of your cornea; correct? A. That's correct.

....

Q. But in December of 1997, you left Dr. Mauer's office with the impression that the April 30, 1997 LASIK procedure was the cause of your visual problems? A. Yes.

Mauer examined Ratcliff on several occasions from December 23, 1997 through February 14, 2002.

Ratcliff saw Gothard on November 18, 1998, and Gothard's medical notes of that visit state:

[Ratcliff] apparently had gotten a second opinion sometime since the last visit when I saw him, with Dr. Mauer who told him he had no effect or very little effect from the cataract and that it was mainly a problem with the LASIK surgery that was causing his vision to be blurry....

....

He is absolutely convinced that the LASIK surgery on the OS has made the cataract and also made his vision blurry. I have told him that there is absolutely no known association between LASIK and cataract formation. He was extremely confrontational and said that there is no way that we can know for sure that this did not cause the cataract, or cause his vision to be blurry.... [H]e really has his mind made up already regarding the cause of his problem. He is very reluctant to get glasses. He says the surgery was an entire waste, and now he has poor vision. I've told him that he may have had a mild amount of myopic regression from the surgery, but I would be a little reluctant to perform any additional laser surgery at this juncture due to the fact that there is a cataract forming and the refraction has been changing.

On November 20, 1998, Graether wrote Ratcliff telling him that the cataract was "merely coincidence" and had nothing to do with the surgery to the eye. Graether also wrote that because of the developing cataract no further refractive surgery should be done to improve Ratcliff's vision. "[A]ny improvement," wrote Graether, "would only be transient."

In a letter dated February 22, 2002, Mauer opined that Ratcliff's poor vision was due to an irregular astigmatism. He attributed the condition to several factors, including the surgical procedures employed to treat Ratcliff's left eye.

II. Proceedings.

On November 16, 2000, Ratcliff sued Graether and Wolfe Clinic. Ratcliff alleged that the defendants combined different procedures in a two-step process in their attempt to correct the myopia of negative ten diopters in his left eye. He further alleged that such process had not been studied or approved by the FDA. Ratcliff also alleged that he would not have consented to such a procedure if he had known these facts, and the defendants suppressed the information to get him to consent.

The defendants asserted a number of affirmative defenses, one of which is the subject of this appeal: Ratcliff's claims are barred by the two-year statute of limitations found in Iowa Code section 614.1(9).

Later, the defendants filed a motion for summary judgment, asserting that the action was time-barred by section 614.1(9). Ratcliff resisted, contending that the continuous treatment doctrine tolled the statute of limitations. The district court denied the motion, ruling that genuine issues of material fact existed. The ruling discussed the possible application of the continuous treatment doctrine.

Following the district court's ruling, the defendants filed their second motion for summary judgment. In it the defendants asked the court to assume, for the purposes of the motion only, that the continuous treatment doctrine would be adopted and would be applied in this case. Even assuming adoption of the continuous treatment doctrine, the defendants contended the single act exception applied to the case and the action was therefore barred by the statute of limitations.

The district court granted the motion and dismissed the case. The district court noted that Ratcliff saw Mauer in December 1997 and left his office with the impression that the April 30, 1997 LASIK procedure was the cause of his visual problems. Under these circumstances, the district court reasoned, it was inappropriate to apply the continuous treatment doctrine after December 1997. The court concluded that because the statute of limitations expired in 1999 and Ratcliff did not file his petition until November 2000, the action was barred.

Ratcliff filed a motion to enlarge or amend findings pursuant to Iowa Rule of Civil Procedure 1.904(2). In its ruling on this motion, the district court concluded that the single act exception applied because Ratcliff was on immediate notice of his injury when, following the surgery, his left eye vision was impaired. The court reasoned that, under the single act exception, if there is a single act of malpractice, subsequent time and effort to remedy or cure the act does not toll the statute of limitations. Additionally, the court ruled, even if the continuous treatment doctrine were to be applied in this case, it could not be applied later than the December 1997 consultation with Mauer.

Following this latter ruling, Ratcliff appealed.

III. Issues.

On appeal, Ratcliff raises three issues, only one of which we need to address: whether the continuous treatment doctrine applies to toll the statute of limitations.

IV. Scope of Review.

We recently summarized rules governing motions for summary judgment in Berte v. Bode:

"Summary judgment is...