By Damian D. Capozzola, Esq.
The Law Offices of Damian D. Capozzola, Los Angeles
Jamie Terrence, RN
President and Founder, Healthcare Risk Services; Former Director of Risk Management Services (2004-2013), California Hospital Medical Center, Los Angeles
News: A hospital won dismissal of a medical malpractice action under the Federal Tort Claims Act (FTCA) after the court applied the home state’s statute of repose for medical malpractice claims to find the clock had run out on the patient’s claim. Because the patient’s case was filed against a hospital operated by the federal government, the patient first sought to resolve her case — which involved significant amputation of her hands and feet — administratively, only filing her case after several years of administrative efforts failed. Faced with the decision of whether to apply North Carolina’s statute of repose — which imposes a time limit of four years in filing medical malpractice claims — or finding the FTCA “pre-empts” these state laws, the court ruled the FTCA does not pre-empt the state statute of repose, but instead, incorporates it. Accordingly, the court lacked subject matter jurisdiction.
This ruling emphasizes the importance of understanding state-specific statutes of repose in medical malpractice claims as well as the potential implications of federal law that may apply.
Background: A woman with a medical condition involving acute nontraumatic right flank pain, nausea, and vomiting arrived at the hospital. She was diagnosed with a 3 mm kidney stone causing hydronephrosis, a common complication of kidney stones. The patient’s condition rapidly deteriorated. The patient returned the next day with symptoms consistent with systemic inflammatory response syndrome and septic shock, and was transferred to an intensive care facility. The prolonged use of vasopressor medications to support the patient’s blood pressure resulted in dry gangrene in her fingers and toes. The patient’s feet and hands were amputated, and she suffered a stroke.
Before filing the lawsuit in court, the patient underwent the administrative claims process as mandated by the FTCA. This involved filing a claim with the Department of the Navy in June 2018. After more than four years, this process culminated with the Department of the Navy denying the patient’s claim, citing her subsequent filing of the lawsuit in October 2022 as the basis for the denial.
The hospital moved to dismiss the lawsuit, arguing the home state’s statute of repose for medical malpractice claims sets a four-year time limit for filing such actions from the last act giving rise to the cause of action. On that basis, the hospital argued, the patient’s claims were time-barred under North Carolina law.
The plaintiff claimed if the statute of repose were applied, the FTCA’s purpose of facilitating administrative resolution would be hindered. The pursuit of administrative resolution required time beyond the four-year statute of repose through no fault of her own. The plaintiff argued patients in similar situations would be forced to prematurely seek judicial relief by filing lawsuits, which would undermine the administrative process envisioned by the FTCA.
The court noted the FTCA provides a limited waiver of the United States’ sovereign immunity, but this waiver is subject to specific limitations. The court determined the FTCA’s waiver of sovereign immunity only applies to the United States if a private person would be liable under the law of the state where the alleged act or omission occurred. Since the plaintiff’s medical malpractice claim was time-barred by the home state’s statute of repose, the FTCA’s waiver did not apply, and the court had no subject matter jurisdiction.
What This Means to You: As a medical matter, one consideration in this case is obtaining informed consent from the patient receiving vasopressors. To maintain blood pressure, these drugs constrict peripheral blood flow to maintain flow to vital internal organs. This loss of adequate blood flow to hands and feet can result in death of tissue and infection with anaerobic bacteria, resulting in gangrene. Antibiotics are ineffective, and amputations become life-saving procedures. If patients are informed of the possible effects of these medications, litigation may be less likely.
Moreover, this ruling serves as a reminder of the importance of state-specific statutes of repose and their implications on medical practice and potential litigation, especially in circumstances interacting with federal law, where applicable.
First, courts may strictly apply statutes of repose under the FTCA. When applied strictly, statutes of repose can lead to seemingly harsh outcomes, such as here, where the patient was left without hands or feet. Unlike statutes of limitation, where a plaintiff might successfully argue the limitations period should be tolled because the patient did not discover the claim until a later date, statutes of repose impose an absolute deadline within which a claim must be filed, regardless of whether the plaintiff discovers the injury or negligence later. This decision shows statutes of repose often are rigidly enforced to achieve their legislative intent, which is to establish an absolute barrier preventing certain claims not filed within the repose period.
In its analysis, the court did note other district courts have decided the same issue differently by holding the FTCA did replace a state’s statute of repose. But this court determined all circuit courts that have considered the issue found the FTCA does not pre-empt a state’s statute of repose. Given the unanimous support for this interpretation among circuit courts, the trend is in favor of ruling state statutes of repose apply to claims brought under the FTCA.
Second, the case instructs medical malpractice patients and their lawyers to be proactive, even after they quickly initiate administrative proceedings under the FTCA, to ensure the clock does not run out on any subsequent lawsuit. Plaintiff attorneys should adopt a careful approach when filing medical malpractice cases under the FTCA to avoid falling victim to the unforgiving statute of repose. Given the additional administrative procedures required by the FTCA, including filing a claim with the relevant federal agency and undergoing a potentially time-consuming administrative review process, time is of the essence. The administrative review can take years, as this plaintiff discovered. Attorneys need to swiftly initiate the administrative procedures and diligently pursue resolution to minimize delays so that if they must file a claim, they do so before the statute of repose expires. This proactive stance is crucial to preserve the client’s rights and prevent the harsh consequences of missing the narrow window to seek legal redress under the FTCA.
Third, this ruling may have implications beyond North Carolina in any jurisdiction with a statute of repose. The same legal analysis and principles the court in this case used to determine that statutes of repose apply under the FTCA is likely to be the law elsewhere. As the court in this case noted in its decision, every circuit court addressing this question has come out the same way: The statute of repose still applies under the FTCA.
Thus, healthcare providers and their representatives should consult qualified legal counsel and survey the statutes of repose in any jurisdiction where they operate or face potential claims. These statutes have significant ramifications on medical malpractice litigation, and failure to adhere to their strict time limitations can result in the loss of a valid claim. By staying up to date on the specific time frames and requirements set forth in various jurisdictions, healthcare providers can better protect themselves from potential legal challenges and ensure they can effectively respond to any claims that may arise.
Despite what may seem like a harsh result for an amputee barred from bringing a medical malpractice claim, the decision is not surprising, considering the purpose of the FTCA. The federal government can exercise sovereign immunity that greatly restricts tort claims. The purpose of the FTCA is to allow for some tortious actions against the government, where due to this doctrine of sovereign immunity, none would otherwise be allowed to proceed. Courts likely will not expand the FTCA to allow for more claims than Congress intended. In that sense, the decision can be seen as reasonable, even with an outcome that is challenging for the patient.
REFERENCE
- Decided July 18, 2023, in the United States District Court for the Eastern District of North Carolina, Southern Division, Case Number No 22-CV-180-FL.
This ruling serves as a reminder of the importance of state-specific statutes of repose and their implications on medical practice and potential litigation, especially in circumstances interacting with federal law, where applicable.
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