Rock v. Warhank

• Decision Date: 21 November 2008
• Docket Number: No. 05-1753.,05-1753.
• Parties: Pamela G. ROCK and Keith A. Rock, Appellants, v. Rose WARHANK, Blue Grass Family Medical Center a/k/a Family Medical Center of Blue Grass, Robert W. Hartung, Center for Breast Health, and Genesis Medical Center, Appellees.
• Court: Iowa Supreme Court

757 N.W.2d 670

Pamela G. ROCK and Keith A. Rock, Appellants, v. Rose WARHANK, Blue Grass Family Medical Center a/k/a Family Medical Center of Blue Grass, Robert W. Hartung, Center for Breast Health, and Genesis Medical Center, Appellees.

No. 05-1753.

Supreme Court of Iowa.

November 21, 2008.

Robert Gallagher and David A. Millage of Gallagher, Millage & Gallagher, P.L.C., Davenport, for appellants.

Constance M. Alt, Sarah J. Gayer, and Tricia L. Hoffman-Simanek of Shuttleworth & Ingersoll, P.L.C., Cedar Rapids, for appellee Robert W. Hartung, M.D.

Richard J. Trinrud of Brooks & Trinrud, Davenport, for appellee Rose Warhank, M.D.

Charles E. Miller and Diane Reinsch of Lane & Waterman, L.L.P., Davenport, for appellees Genesis Medical Center and Center for Breast Health.

STREIT, Justice.

Pamela Rock sued her doctors for failing to diagnose her breast cancer. She alleged their negligence caused her cancer to spread to her lymph nodes. The district court granted the doctors' motion for summary judgment holding the statute of limitations barred Rock's claim. The court of appeals affirmed. Because Rock could not have known, and would not have known through reasonable diligence, of her injury and its cause, as a matter of law, more than two years prior to filing her claim, we vacate the decision of the court of appeals and reverse the judgment of the district court.

I. Facts and Prior Proceedings.

Pamela Rock noticed a lump in her left breast in May 2002. She called Dr. Warhank at the Family Medical Center in Blue Grass to have it examined. Rock was referred to the Center for Breast Health for a bilateral mammogram, which was performed on May 28. Rock had a follow-up appointment with Dr. Warhank on June 3. Dr. Warhank palpated Rock's left breast and located the lump. Dr. Warhank told Rock the mammogram was normal and not to worry about the lump.

Sometime on June 3 or 4, Rock received a call requesting she come in for additional views of her right breast. Rock went to the Center for Breast Health on June 4 and had additional views of the right breast taken. A technician told Rock an ultrasound was not necessary because what was seen in the earlier mammogram was no longer present. Rock reminded the technician she had a lump in her left breast and not her right breast. The technician assured Rock nothing was seen on the earlier mammogram of her left breast so she should not worry about the lump anymore. Dr. Hartung reviewed the radiology report of the right breast and advised Rock in a letter dated June 5 that the additional views of the right breast showed no sign of cancer.

In September 2002, Rock was still concerned about the lump in her left breast. She made an appointment with Dr. Kelly at the Family Medical Center. Dr. Kelly told Rock the lump was "probably benign." Nevertheless, Dr. Kelly recommended a surgical consult and referred Rock to Dr. Congreve.

Dr. Congreve performed a fine-needle aspiration on September 25. Two days later, Dr. Congreve called Rock and told her the test was not normal and she needed to have a biopsy of her left breast. On October 8, 2002, Dr. Congreve performed the biopsy and diagnosed Rock with breast cancer. Rock met with Dr. Congreve on October 11. He informed her additional tissue in her left breast needed to be removed because he did not believe he got all of the cancer. On October 18, Dr. Congreve removed the additional tissue and six lymph nodes. Five of the six nodes were cancerous. Rock had an additional surgery to remove another six nodes, one of which was cancerous. Rock was also treated with chemotherapy.

Rock filed suit against Dr. Warhank and Dr. Hartung and their employers on October 5, 2004. She claims Dr. Warhank and Dr. Hartung failed to properly examine, diagnose, and treat the cancer in her left breast. As a result of this alleged negligence, Rock claims the cancer spread to six of her twelve lymph nodes causing additional medical treatment and expense and decreasing her life span.

The defendants filed a motion for summary judgment alleging Rock's lawsuit was barred by the statute of limitations. See Iowa Code § 614.1(9) (2003). The district court agreed and granted the motion. Rock appealed. We transferred the case to the court of appeals, which affirmed the district court. We granted further review and now reverse.

II. Standard of Review.

A summary judgment ruling is reviewed for correction of errors at law. James Enter., Inc. v. City of Ames, 661 N.W.2d 150, 152 (Iowa 2003). Summary judgment is appropriate

if the pleadings, depositions, answers to interrogatories, and admissions on file, together with the affidavits, if any, show that there is no genuine issue as to any material fact and that the moving party is entitled to a judgment as a matter of law.

Iowa R. Civ. P. 1.981(3). A question of fact exists "if reasonable minds can differ on how the issue should be resolved." Walker v. Gribble, 689 N.W.2d 104, 108 (Iowa 2004). The party resisting the motion for summary judgment should be afforded every legitimate inference that can reasonably be deduced from the evidence. Clinkscales v. Nelson Secs., Inc., 697 N.W.2d 836, 841 (Iowa 2005).

III. Merits.

The issue before us is whether Rock's lawsuit was untimely. This case requires us to revisit the language of our statute of limitations for medical malpractice. Our goal is to ascertain legislative intent, which is determined by the words chosen by the legislature. Iowa Ass'n of Sch. Bds. v. Iowa Dep't of Educ., 739 N.W.2d 303, 309 (Iowa 2007). When the language of a statute is plain and its meaning clear, the rules of statutory construction do not permit us to search for meaning beyond the statute's express terms. City of Waterloo v. Bainbridge, 749 N.W.2d 245, 248 (Iowa 2008).

Under Iowa Code section 614.1(9), medical malpractice claims 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 existence of, the injury ... for which damages are sought." "Injury" within the context of the statute is the physical or mental harm incurred by the plaintiff. Langner v. Simpson, 533 N.W.2d 511, 517 (Iowa 1995).

Previously, we held the statute of limitations begins to run as soon as the plaintiff knew or should have known of the physical or mental harm for which damages are sought. Schlote v. Dawson, 676 N.W.2d 187, 194 (Iowa 2004); Langner, 533 N.W.2d at 517. In Rathje v. Mercy Hospital, 745 N.W.2d 443 (Iowa 2008), we acknowledged our past cases may not have correctly captured the intent of the legislature. Rathje, 745 N.W.2d at 447. After reviewing over a hundred years of jurisprudence and the history of the tort reform movement, we came to the conclusion the statute of limitations for medical malpractice claims does not begin to run until the plaintiff knew, or should have known through reasonable diligence, of both the physical or mental harm and its cause in fact. Id. at 460-61. We held the plaintiff must have known, or should have known through reasonable diligence, the medical care caused or may have caused the injury. Id. at 461. However, it is not necessary for the plaintiff to discover the medical professional was negligent in order to trigger the statute of limitations. Id. at 462-63. The standard for summary judgment then is whether a reasonable fact finder could conclude Rock filed her claim within two years of when she first knew or should have known of her injury and its cause. See Murtha v. Cahalan, 745 N.W.2d 711, 718 (Iowa 2008) (stating "[e]ven if a fact finder concludes that [the plaintiff's] lump developed into cancer or her cancer progressed, i.e., she sustained an "injury" for section 614.1(9) purposes, prior to the two-year period preceding the filing of her lawsuit, it is still a fact question under this record as to when she knew, or should have known, of that injury and its cause in fact"); Rathje, 745 N.W.2d at 463 (holding "a reasonable jury could find [the plaintiffs] did not know the cause of the harm until, at the earliest, April 27, 1999, the date the gastroenterologist made a diagnosis of "drug-induced hepatitis secondary to antabuse").

We filed Murtha on the same day as Rathje. Murtha provided an occasion to further refine our definition of "injury" when a plaintiff, as in this case, alleges negligent misdiagnosis. See Murtha, 745 N.W.2d at 715. In Murtha, we said

the "injury" does not occur merely upon the existence of a continuing undiagnosed condition. Rather, the "injury" for section 614.1(9) purposes occurs when "the problem grows into a more serious condition which poses greater danger to the patient or which requires more extensive treatment."

Id. at 717 (quoting DeBoer v. Brown, 138 Ariz. 168, 673 P.2d 912, 914 (1983)). Thus, two questions must be answered to determine when the statute of limitations begins to run under section 614.1(9) in a negligent misdiagnosis case. First, one must determine at what stage a plaintiff's condition became an "injury," i.e., when did the problem worsen so that it posed a greater danger to the plaintiff or required more extensive treatment. Id. Second, one must determine when the plaintiff knew, or should have known through reasonable diligence, of the injury and its cause in fact. Id. In Murtha, we said both of these inquiries are "highly fact-specific." Id. Consequently, as we said in Murtha, they cannot be resolved as a matter of law unless no reasonable fact finder could conclude the lawsuit was filed within two years of when the plaintiff knew or should have known of the injury and its cause.

Here, Rock alleges Drs. Warhank and Hartung's failure to properly diagnose her cancer in May and June 2002 when she reported a lump in her left breast caused her cancer to worsen and spread into her lymph nodes. When Rock's injury occurred must be determined by expert testimony. Since the parties in this action did not have the benefit of...