On appeal from the Superior Court, Appellate Division.
(This syllabus is not part of the opinion of the Court. It has been prepared by the Office of the Clerk for the convenience of the reader. It has been neither reviewed nor approved by the Supreme Court. Please note that, in the interests of brevity, portions of any opinion may not have been summarized).
This appeal deals with the application of the discovery rule to toll the running of the statute of limitations in a medical malpractice action.
In 1987, plaintiff, Rafaela Guichardo, was involved in an automobile accident that resulted in a condition known as RefleX Sympathetic Dystrophy Syndrome, which caused Guichardo to suffer severe pain to the right side of her neck, upper right arm, back, and shoulders. Dr. Philip Rubinfeld treated plaintiff with a series of thoracic epidural catheterizations to alleviate the pain.
On September 21, 1992, Dr. DeLisi admitted paintfiff to Dover General Hospital so that Dr. Rubinfeld could perform another catheterization. During that procedure, Dr. Rubifeld experienced some difficulty while inserting the catheter and as a result punctured Guichardo's back numerous times. Another physician finally was able to insert the catheter. During her subsequent hospital stay, the sterile dressing holding Guichardo's catheter in place remained unchanged, despite the appearance of drainage on the dressing. Guichardo was discharged from the hospital four days later, after the catheter was removed.
Within a week of her discharge, Guichardo began to experience numbness and tingling from the waist down and difficulty with urination and bowel movements. Dr. DeLisi re-admitted her to the hospital on October 1, 1992. Two days after her re-admission, plaintiff was having problems walking without assistance. On examination, Dr. DeLisi noticed pus at the site of the epidural catheter, and told Guichardo that something had gone wrong with the thoracic epidural. He diagnosed Guichardo with an epidural abscess and ordered her to the operating room for surgery to remove the abscess. The abscess, which was compressing plaintiff's spinal cord, was removed, but Guichardo did not regain the ability to walk.
Several days after her surgery, Dr. Rubinfeld visited Guichardo in her hospital room. She asked him whether he had done anything wrong that might have caused her paraplegia. According to Guichardo, Dr. Rubinfeld denied having done anything wrong but expressed his disappointment at not having been called when she was admitted to the hospital because he would have known what went wrong and how to respond in less time. Following a course of antibiotics, Guichardo was discharged from the hospital on November 2, 1992.
In August 1994, before filing her complaint in the Law Division, Guichardo consulted an expert, who concluded that her health care providers had been negligent during the insertion of the catheter, as well as during her first hospital stay in September. That expert did not offer an opinion regarding whether Dr. DeLisi deviated from accepted standards in the care he rendered.
In September 1994, Guichardo filed a personal injury action against Dover General Hospital, Dr. Rubinfeld, and others involved with her care during her September 1992 hospital admission. Thereafter, in December 1994 and April 1995, Guichardo's attorney consulted with two additional medical experts to determine whether the treatment she received during her October 1992 hospital stay deviated from accepted standard of care, causing her paralysis. Neither expert concluded that Dr. DeLisi or any other post-epidural care provider had been negligent. In July 1995, Guichardo's counsel contacted a fourth expert, Dr. Hetherington, who concluded that Dr. DeLisi's delay in diagnosing the epidural abscess was a contributing factor to her paraplegia.
In March 1996, Guichardo amended her complaint to add Dr. DeLisi as a defendant. Dr. DeLisi filed a motion for summary judgment, asserting the time bar of the statute of limitations. Dr. DeLisi alleged that Guichardo knew of facts sufficient to trigger the running of the statute of limitations as early as September or October 1992. The trial court granted the motion, stating that plaintiff had sufficient information to alert her that Dr. DeLisi's delay in diagnosing her abscess may have contributed to her paraplegia. The trial court therefore held that the discovery rule did not apply to toll the running of the statute of limitations in respect of Guichardo's claim against Dr. DeLisi and dismissed plaintiff's claim against him. Subsequently, another direct defendant filed a third-party complaint against Dr. DeLisi.
In February 2000, following the trial court's dismissal of plaintiff's complaint against Dr. DeLisi, the New Jersey Supreme Court decided two companion cases in which it applied the discovery rule where plaintiffs initially had relied on expert advice indicating that third-party physicians were not at fault, but later heard from other experts to the contrary. Based on the Court's decision in those cases, Guichardo filed a motion for reconsideration of the trial court's 1997 granting of Dr. DeLisi's motion for summary judgment. Citing the Supreme Court's decision in those earlier cases and plaintiff's reliance on her initial experts, the trial court concluded that Guichardo reasonably did not become aware of Dr. DeLisi's negligence until she received the opinion of her fourth expert, Dr. Hetherington. Thus, the trial court granted Guichardo's motion for reconsideration and vacated its earlier grant of summary judgment for Dr. DeLisi.
The Appellate Division granted Dr. DeLisi leave to appeal. The panel agreed with Dr. DeLisi's argument that plaintiff was well-aware at an early date of the facts supporting her clam against him and concluded that plaintiff's knowledge of the facts and her belief that Dr. DeLisi bore some responsibility were sufficient to bar application of the discovery rule. The Appellate Division reversed the vacation of summary judgment and remanded the matter for an order dismissing plaintiff's complaint against Dr. DeLisi.
The Supreme Court granted Guichardo leave to appeal.
HELD: The discovery rule operates to toll plaintiff's cause of action against a particular physician in this multi-party medical malpractice case where plaintiff reasonably relied on earlier expert advice indicating an absence of fault on the part of that particular physician and application of the discovery rule did not unduly prejudice that physician, who already had participated in and defended against the litigation by virtue of an earlier third-party complaint.
1. To avoid the potentially harsh effects of the mechanical application of statutes of limitations, New Jersey courts have long employed the equitable principle of the discovery rule, which delays accrual of a cause of action until the injured party discovers, or by exercise of reasonable diligence and intelligence should have discovered, that he may have a basis for an actionable claim. In a complex medical causation case, more than mere speculation of causal connection between the plaintiff's condition and the third party's conduct is required to start the statute of limitations running. (pp. 8-9)
2. Although the discovery rule does not require knowledge of a specific basis for legal liability or a provable cause of action, it does require knowledge not only of the injury but also that another is at fault. The Court has applied the discovery rule to medical malpractice cases in which the plaintiffs knew that they had been injured and that the injury was the fault of another, but did not know that a third party was also responsible for their plight. (pp. 9-12)
3. Plaintiff reasonably relied on earlier expert advice indicating an absence of fault on the part of Dr. DeLisi, and Dr. Rubinfeld's earlier vague and self-serving comments suggesting that Dr. DeLisi's delay in ordering surgery may have contributed to plaintiff's paraplegia did not constitute reasonable medical support for a claim against Dr. DeLisi to start the running of the statute of limitations. (pp. 12-13)
4. Since Dr. DeLisi has been an active participant in the litigation by virtue of the third-party claim another defendant filed against him, he will not be prejudiced by the application of the discovery rule to plaintiff's direct claim against him. (p. 14)
5. The Court's application of the discovery rule to this case will not promote an open-ended process that allows a plaintiff an indefinite period in which to search for an expert willing to support a preferred theory of liability. (pp. 14-15)
Judgment of the Appellate Division is REVERSED and the matter is REMANDED to the Law Division to REINSTATE the June 2000 order that vacated the 1997 summary judgment order in favor of Dr. DiLisi.
JUSTICE VERNIERO has filed a separate dissenting opinion in which JUSTICES COLEMAN and LaVECCHIA join. Justice Verniero believes that plaintiff's cause of action against Dr. DeLisi accrued in October 1992 on the basis of Dr. Rubinfeld's statement regarding the delay in her surgery. He further believes that the majority's holding departs from established law and that the Court's rationale will leave lower courts with little choice in the application of the discovery rule, resulting in receipt of an expert report as the triggering mechanism in all medical malpractice actions.
CHIEF JUSTICE PORITZ and JUSTICES LONG and ALBIN join in JUSTICE ZAZZALI's opinion. JUSTICE VERNIERO has filed a separate dissenting opinion in ...