It is a well-known fact that most cases never make it to trial. There are many reasons for this, including: settlement, dismissal, and all sorts of legal technicalities that prevent a case from moving forward. One common reason why cases fail is that they fall outside the statute of limitations, which sets out how much time a person has from the injury (or discovery of the injury) to institute a lawsuit.
In this month’s case, the 2nd United States Circuit Court of Appeals looked at the continuous treatment doctrine in order to determine whether a plaintiff’s lawsuit could move forward.
Facts of the Case
The patient, Mr C, was a United States Armed Services veteran who received his health care from the Department of Veterans Affairs (VA).
Mr C was first treated in 2015 for complaints of leg pain and swelling, which worsened over time. His VA provider did not diagnose the cause of Mr C’s symptoms, but in 2017, a VA hospital determined that the cause of the patient’s symptoms was deep vein thrombosis.
Mr C was placed on a course of anticoagulation treatment for a year. In 2019, Mr C was examined again and was informed that the treatment had been unsuccessful, and his condition was permanent.
In early 2021, Mr C filed a pro se lawsuit (he represented himself) against the United States alleging that he had received deficient care from the VA based on the failure of his VA provider to diagnose deep vein thrombosis in 2015, when he first sought treatment.
The statute of limitations under the Federal Tort Claims Act which governs cases filed against federal agencies such as the VA is 2 years. The government made a motion to dismiss the case claiming that the statute of limitations began when the patient’s deep vein thrombosis was diagnosed in 2017, and thus it expired in 2019.
In response, Mr C claimed that the continuous treatment doctrine should extend the statute of limitations until 2019, as he was still under the care of the VA. The lower court disagreed with this argument, holding that while Mr C had continued treatment with the VA, he was not treated by the same provider, and thus the treatment was not continuous.
Mr C appealed to the 2nd Circuit Court of Appeals.
The Court Rules
The 2nd Circuit Court of Appeals reversed the lower court’s decision and held that a patient’s care is still continuous if they treat with separate providers all employed by the named defendant.
Under the Federal Tort Claims Act (FTCA), claimants have 2 years from the date of the injury or when the injury was discovered, or should have been discovered, to file a lawsuit. The continuous treatment doctrine allows tolling of the statute of limitations under certain circumstances until the end of treatment.
The Court of Appeals noted that under normal circumstances, Mr C’s claims accrued on November 27, 2017 when an ultrasound performed at the hospital revealed that deep vein thrombosis was the cause of the patient’s pain and leg swelling. Mr C alleged, however, that he was continuously treated at the hospital from the November date until February 19, 2019, when he was told that the treatment had failed, and that further anticoagulation medication would not be helpful. At that point he was told that his condition was permanent.
“Based on these allegations,” wrote the court, “we conclude that the district court erred in finding, at the pleading stage, that the continuous treatment doctrine has no application to Mr C’s claims. The district court reasoned that the doctrine does not apply because Mr C failed to allege he was continuously treated by the same government physician after his emergency department visits. But we have never held that application of the doctrine as applied to FTCA claims, requires continuous treatment by the same physician. To the contrary, we have explained that one central rationale for the doctrine holds it absurd to expect a patient being treated by a doctor or hospital to interrupt corrective treatment by instituting suit against either while under their continuing care.”
The Court of Appeals noted that when Mr C was diagnosed with deep vein thrombosis in 2017, he was put on a treatment of anticoagulation medication, and then given another ultrasound in January 2019, before being told that his condition was permanent in February 2019. “Instituting suit before February 19, 2019, would have required him to potentially interrupt his correcting treatment to assert claims against hospital staff while under their continuing care. Mr C has therefore pleaded a plausible basis for tolling the statute of limitations until February 19, 2019, which was less than 2 years before he submitted his claim to the Department of Veterans Affairs on January 17, 2021. “
The court held that the district court had erred in dismissing Mr C’s claims, and it remanded the case back to the lower court for further proceedings.
Protecting Yourself
The continuous treatment doctrine is commonly used by patients seeking to extend the statute of limitations in medical malpractice cases, but the doctrine is still evolving. This case has extended it to treatment at the same facility for the same issue but did not require the treating provider to be the same. It will be important in the future to follow other continuous care doctrine cases to see if courts continue to broaden its interpretation. Anything which can extend the statute of limitations can be a liability for health care practitioners.
