Where a patient left the hospital with known pressure ulcers and no wound treatment plan, the statute of limitations for his HCLA (health care liability act, formerly known as medical malpractice) claim related to those skin wounds began to run on the day he was discharged from the hospital.
In Jackson v. Vanderbilt University Medical Center, No. M2022-00476-COA-R3-CV, 2022 WL 16545403 (Tenn. Ct. App. Oct. 31, 2022), patient was hospitalized at defendant hospital from August 7-24, 2020. During his time there, he “began developing skin breakdowns and pressure ulcers[.]” When patient was discharged on August 24, 2020, he was told to follow up with his primary care physician, but on September 3, patient was taken to a wound treatment center. Patient was later treated at defendant’s trauma center.
Patient died sometime after this time, and this HCLA suit was filed by his next of kin. Plaintiff sent defendant pre-suit notice of his claim on August 28, 2021, then filed this complaint on November 18, 2021, asserting that defendant’s “negligence caused [patient] to develop pressure ulcers, skin impairment, and infection…” Defendant filed a motion to dismiss, arguing that the suit was filed outside the statute of limitations. The trial court agreed with defendant that the statute of limitations began to run August 24, 2020, the date patient was discharged, and that the pre-suit notice letter was therefore sent after the limitations period had expired. Plaintiff was thus not entitled to the 120-day time extension under the HCLA, and the trial court granted dismissal based on untimeliness. This ruling was affirmed on appeal.
Suits brought under the HCLA are subject to a one-year statute of limitations. (Tenn. Code Ann. § 29-26-116(a)(1)). Under the HCLA, “a plaintiff who complies with the notice requirements…receives a 120-day extension on the statute of limitations,” but “receipt of the extension is predicated on the pre-suit notice being provided within the original limitations period.” (internal citations omitted). Here, the issue was whether the pre-suit notice letter was sent by plaintiff “more than one year after the cause of action accrued and the one-year statute of limitations period began to run.”
While “a cause of action generally accrues when an injury occurs,” application of the discovery rule may change the date on which the limitations period begins to run. For HCLA claims, the discovery rule means that a “cause of action accrues when one discovers, or in the exercise of reasonable diligence should have discovered, both (1) that he or she has been injured by wrongful or tortious conduct and (2) the identity of the person or persons whose wrongful conduct caused the injury.” (internal citation omitted). Even under the discovery rule, however, plaintiffs cannot simply wait “until [they] know the full extent of their damages, the exact nature of their legal claims, or all the facts affecting the merits of their claims.” (internal citation omitted).
Applying the discovery rule to this case, the Court of Appeals agreed with the trial court that the limitations period began to run no later than August 24, 2020, the date the patient was discharged from the hospital. It was undisputed that the patient began developing the pressure ulcers during his stay in mid-August, and that he was discharged with existing wounds and “no pressure ulcer wound care instructions or pressure ulcer ointment.” The Court explained that the complaint pointed to this release without instructions or wound care as alleged negligence, and that “these allegations are sufficient, in and of themselves, to establish [defendant’s] statute of limitations defense.” (internal citation and quotation omitted).
Because defendant established the statute of limitations defense, the burden was on plaintiff to show that some tolling rule should apply to avoid dismissal. While plaintiff attempted to rely on the discovery rule, the facts of the case did not support his argument. The Court reasoned:
Other than a conclusory reference to the care that occurred in September 2020, [plaintiff] has not provided any argument to suggest that [patient’s] injury or [defendant’s] alleged negligence were not known and could not have been discovered at the time of his August 24, 2020 discharge. Nothing in [plaintiff’s] complaint indicates that [patient’s] injury was concealed at the time of his discharge or that it was unknown that [defendant] was the entity providing the allegedly negligent care. Moreover, nothing in [plaintiff’s] complaint or argument suggests that by August 24, 2020, [patient] did not, at least, have information sufficient to alert a reasonable person of the need to investigate the injury. Instead, [plaintiff’s] complaint alleges that [patient] was suffering from an injury as of August 24, 2020, to such an extent that the alleged failure to provide him with at-home wound care instructions was negligent.
(internal citations and quotation omitted).
Based on these facts, the Court found that “[patient’s] injury and [defendant’s] role in that injury should have been discovered on or before August 24, 2020.” The pre-suit notice letter was thus sent after the expiration of the statute of limitations, plaintiff was not entitled to the 120-day limitations period extension, and the complaint was time-barred. Dismissal was accordingly affirmed. This case illustrates the importance of sending your HCLA pre-suit notice letter within the one-year statute of limitations for health care claims and carefully analyzing when the limitations period for your HCLA claim began to run.
This opinion was released two months after this case was assigned on briefs.
Note: Chapter 50, Section 3 of Day on Torts: Leading Cases in Tennessee Tort Law has been updated to include this decision.
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