Laura Denvir Stith, Judge
Shonda Ambers-Phillips and her husband, Richard Phillips, II, appeal the trial court's dismissal with prejudice of their medical malpractice and related claims against SSM DePaul Health Center for leaving foreign objects in her abdomen
This Court also reaffirms its prior cases rejecting the Phillipses' alternative argument that statutes of repose are unconstitutional if not subject to equitable tolling. While the Phillipses are correct that the right to bring suit for medical malpractice is one protected by the right to jury trial and may not be unreasonably foreclosed, this Court rejects the argument that it is a fundamental right to which heightened scrutiny applies. The Phillipses, therefore, must show that the legislature's decision to adopt a statute of repose was without rational basis. They have failed in meeting this burden. Statutes of limitations always have limited the time period for filing suit, and when the legislature extended the statute of limitations for medical malpractice by adopting a discovery rule, its decision also to adopt an absolute limit on the time within which the action could be filed was not unreasonable. Neither did it violate the prohibition against special laws or the guarantee of open courts. For these reasons, the judgment is affirmed.
On September 13, 1999, Ms. Ambers-Phillips was in a car accident. She underwent an exploratory laparotomy at SSM DePaul. Nearly 14 years later, in June 2013, she underwent another exploratory laparotomy at a different St. Louis-area hospital because she was having pain in her side. According to the petition, during the surgery her doctors found four foreign objects that had been left inside her abdomen during the 1999 surgery. She sued SSM DePaul in 2013, alleging that it committed medical malpractice in failing to account for and remove these four foreign objects during her 1999 laparotomy.
SSM DePaul moved to dismiss the Phillipses' claims on numerous grounds, including that they were barred by section 516.105's 10-year statute of repose for claims of medical negligence involving the leaving of foreign objects in the body.
This Court reviews a trial court's grant of a motion to dismiss a petition de novo. Lynch v. Lynch, 260 S.W.3d 834, 836 (Mo. banc 2008). This Court also reviews the constitutional validity of a statute de novo. In re Brasch, 332 S.W.3d 115, 119 (Mo. banc 2011). A statute is presumed to be valid, and the Court will uphold it unless it "clearly and undoubtedly" conflicts with the constitution. Prokopf v. Whaley, 592 S.W.2d 819, 824 (Mo. banc 1980). The Court "resolve[s] all doubt in favor of the [statute's] validity." Westin Crown Plaza Hotel Co. v. King, 664 S.W.2d 2, 5 (Mo. banc 1984).
From 1921 until 1976, cases alleging that a foreign object was left in the body were subject to the general statute of limitations governing certain intentional torts and medical malpractice, which stated in relevant part:
Applying this statute to a medical malpractice case, Laughlin v. Forgrave, 432 S.W.2d 308, 310, 313 (Mo. banc 1968), held that the statute barred the suit brought by a patient in 1963 against the doctors who had left a foreign object in her back during surgery that occurred in 1951. Laughlin rejected the patient's argument that the statute of limitations should have been tolled from 1951 until her discovery of the foreign object in 1962. Id. at 313-14. In so doing, Laughlin said her argument in favor of a discovery rule "is appealing and has some force, so far as justice is concerned; in that respect the conclusion we reach is distasteful to us." Id. at 314. Nonetheless, the plaintiff could not recover, for:
Id. Eight years later, in 1976, the legislature took action that in part addressed the unfairness that had concerned this Court in Laughlin by adopting section 516.105, RSMo Supp. 1976. That section sets out a discovery rule for foreign object medical malpractice cases as part of the medical
(Emphasis added). As this Court later noted in Weiss v. Rojanasathit, 975 S.W.2d 113 (Mo. banc 1998), by this enactment the legislature provided:
Id. at 117. Under section 516.105, when the negligent act is discovered, the statute of limitations begins running.
The discovery rule adopted in the 1976 revision to section 516.105 was not unlimited, however. In a classic example of a statute of repose, its final clause provided that no suit could be brought more than 10 years after the foreign object was left in the body, without regard to whether the negligent act had at that point been discovered:
§ 516.105, RSMo Supp. 1976.
Section 516.105 was amended in 1999, but the time limit for bringing suit in foreign object cases remained the same:
§ 516.105, RSMo Supp. 1999.
This Court first must decide whether the Phillipses' suit was timely brought under section 516.105 as written or as modified by the doctrine of equitable tolling. The Phillipses' suit was filed on November 21, 2013, within two years from the date Ms. Amber-Phillips discovered, in June 2013, that four foreign objects had been left in her body. But this was not within 10 years after she alleges the foreign objects were left in her abdomen during her surgery at DePaul in September 1999. The Phillipses acknowledge that this means that section 516.105's statute of repose appears to bar their claims. But
In support of their argument, the Phillipses note that, when it applies, equitable tolling "pauses the running of, or `tolls,' a statute of limitations when a litigant has pursued his rights diligently but some extraordinary circumstance prevents him from bringing a timely action." Lozano v. Montoya Alvarez, ___ U.S. ___, 134 S.Ct. 1224, 1231-32, 188 L.Ed.2d 200 (2014). They note that Missouri has recognized the concept of equitable tolling can be applied to statutes of limitations when it is unfair to hold the plaintiff's claim was barred. See Rolwing v. Nestle Holdings, Inc., 437 S.W.3d 180, 184 (Mo. banc 2014). Similarly, in Ross v. Kansas City General Hospital & Medical Center, 608 S.W.2d 397 (Mo. banc 1980), this Court explained the fairness principles that supported the legislature's adoption of a discovery rule in section 516.105 in regard to the statute of limitations in foreign object cases, stating:
Id. at 399. Combining these principles, the Phillipses argue that the same fairness concerns should be applied here and compel "the intervention of equitable tolling of the statute of repose."
While the Phillipses are correct that this Court's prior cases have recognized the fairness of adopting a discovery rule and of equitable tolling in regard to the statute of limitations, they fail to note that these cases have emphasized that it is up to the legislature to determine whether to adopt a discovery rule or equitable tolling in a particular case because "a `statute of limitations may be suspended or tolled only by specific disabilities or exceptions enacted by the legislature and the courts are not empowered to extend those exceptions.'" Rolwing, 437 S.W.3d at 184, quoting Shelter Mut. Ins. Co. v. Dir. of Revenue, 107 S.W.3d 919, 923 (Mo. banc 2003); see also Ross, 608 S.W.2d at 399.
The Phillipses' argument also fails to consider the philosophical and conceptual differences between statutes of limitations and statutes of repose. Equitable tolling is a term almost universally used in the context of statutes of limitations. This is because, unlike statutes of limitations, statutes of repose "by their nature reimpose on some plaintiffs the hardship of having a claim extinguished before it is discovered, or perhaps before it even exists." W. Page Keeton et al., Prosser & Keeton on the Law of Torts § 30, at 168 (5th ed. 1984). The United States Supreme Court itself recently has explained why these differences between statutes of limitations and statutes of repose make the latter incompatible with equitable tolling, stating:
CTS Corp. v. Waldburger, ___ U.S. ___, 134 S.Ct. 2175, 2183, 189 L.Ed.2d 62 (2014).
Although not using the term "equitable tolling," this Court applied these concepts in rejecting an argument that a 10-year statute of repose in a construction case was unreasonable because it cut off the plaintiffs' cause of action before it arose, stating;
Blaske v. Smith & Entzeroth, Inc., 821 S.W.2d 822, 834 (Mo. banc 1991).
Rather than discuss or attempt to distinguish Blaske, the Phillipses instead ask this Court to look at dicta in the decision of the New Jersey Supreme Court in R.A.C. v. P.J.S, Jr., 192 N.J. 81, 927 A.2d 97 (2007). Even under New Jersey law, however, R.A.C. recognized that equitable tolling usually is incompatible with a statute of repose, citing United States Court of Appeals decisions from the Fourth, Seventh, and Tenth Circuits. Id. at 105-06. The court simply said that under the particular wording of its state constitution it thought tolling would be permissible in the extraordinary circumstance where the court believed that tolling was consistent with legislative intent. Id. at 108. R.A.C. did not find that to be the case under the facts before it and, therefore, denied tolling. Id. at 109-10.
The Phillipses alternatively argue that, if section 516.105's statute of repose is not equitably tolled, then it violates the Missouri Constitution's equal protection clause and guarantee of open courts.
The equal protection clause of the Missouri Constitution provides that "all persons are created equal and are entitled to equal rights and opportunity under the law." Mo. Const. art. I, § 2. In considering whether a statute violates the clause, this Court first "determines whether the statute contains a classification that `operates to the disadvantage of some suspect class or impinges upon a fundamental right explicitly or implicitly protected by the Constitution.'" Glossip v. Missouri Dep't of Transp. & Highway Patrol Emps.' Ret. Sys., 411 S.W.3d 796, 801 (Mo. banc 2013). In most other instances, the statute is presumed constitutional and Missouri courts will apply a rational basis test under which "the statute will be [held] valid as long as it bears a reasonable relationship to a legitimate state purpose." Id.; accord State v. Pike, 162 S.W.3d 464, 470 (Mo. banc 2005).
The Phillipses ask this Court to apply strict scrutiny to the statute of repose at issue here even though they do not fall within any traditional suspect class, nor do they assert a right this Court previously has recognized as fundamental. They argue that an expansion of what constitutes a fundamental right to bring their claims is required by the open courts provision of the Missouri Constitution, which guarantees that "the courts of justice shall be open to every person, and certain remedy afforded for every injury to person, property or character, and that right and justice shall be administered without sale, denial or delay." Mo. Const. art. I, § 14. The Phillipses argue that, because the statute of repose bars their cause of action before it even vests or accrues, it denies them their guaranteed right under article I, section 14 of access to the courts and a certain remedy for the wrong committed against them by defendant. The dissenting opinion agrees.
This argument misconstrues the open courts provision. It is well-settled that "[a]n open courts violation is established upon a showing that: (1) a party has a recognized cause of action; (2) ... the cause of action is being restricted; and (3) the restriction is arbitrary or unreasonable." Snodgras v. Martin & Bayley, Inc., 204 S.W.3d 638, 640 (Mo. banc 2006). In other words, as this Court held in Harrell v. Total Health Care, Inc., 781 S.W.2d 58, 62 (Mo. banc 1989), the right of access to the courts set out in the open courts provision of the Missouri Constitution "means simply the right to pursue in the courts
Statutes of repose do not bar the bringing of a valid cause of action. As this Court noted in Blaske in considering whether the open courts provision was violated by the 10-year statute of repose for builders and designers set out in section 516.097, RSMo 1986, the failure to bring suit within 10 years extinguishes the cause of action. Therefore, because the substantive statutory law had extinguished any right to sue at the end of 10 years, the plaintiffs had no cause of action to bring by the time they discovered the wrong at a later point. 821 S.W.2d at 833.
The principles set out in these cases apply here. The open courts guarantee applies only to recognized causes of action; it does not guarantee access to the courts once the statute of repose extinguishes the cause of action. If the Phillipses' right to sue had accrued prior to the time the statute of repose applied, then the open courts provision would be applicable and this Court would examine whether the statute unreasonably restricted their right to bring suit. Cf. Laughlin, 432 S.W.2d at 314 (statute of limitations must allow reasonable time to bring suit). Similarly, if the legislature had prohibited recovery for personal injury, the due process principles recognized by the United States Supreme Court in Poindexter v. Greenhow, 114 U.S. 270, 303, 5 S.Ct. 903, 29 L.Ed. 185 (1885), and relied on by the dissent certainly would be implicated. But, here, the legislature provided a reasonable, 10-year period in which to sue. That period concluded before the Phillipses discovered the wrong; as a result, the Phillipses' right to sue never accrued and, therefore, never vested.
As discussed above, the United States Supreme Court has recognized that the effect of a statute of repose is to extinguish an existing cause of action, and it has applied such statutes. See CTS Corp., 134 S.Ct. at 2187-88. A statute of repose is not inconsistent with due process. The open courts provision is inapplicable to the Phillipses' claim, for it applies only to causes of action that have accrued, not to
Absent the ability to rely on the open courts provision, the Phillipses are unable to support their argument that the right to bring a medical malpractice action is fundamental. To the contrary, fundamental rights normally include free speech, freedom of travel, the right to personal privacy, and other rights that are "objectively, deeply rooted in the nation's history and tradition and implicit in the concept of ordered liberty, such that neither liberty nor justice would exist if they were sacrificed." Doe v. Phillips, 194 S.W.3d 833, 842 (Mo. banc 2006). That is why this Court previously has rejected nearly identical arguments that the right to sue for medical malpractice can fit within this narrow category of fundamental rights.
For instance, in Adams ex rel. Adams v. Children's Mercy Hospital, 832 S.W.2d 898 (Mo. banc 1992), overruled in part by Watts v. Lester E. Cox Medical Centers, 376 S.W.3d 633, 645-46 (Mo. banc 2012) (overruling unrelated portion of Adams approving statutory caps), this Court specifically rejected the argument that the open courts provision guarantees victims of medical malpractice an unlimited time to sue.
This aspect of Adams was reaffirmed in Batek v. Curators of University of Missouri, 920 S.W.2d 895 (Mo. banc 1996). Batek involved a suit by a woman who had experienced malpractice when 20 years old. She argued that it violated equal protection not to toll the running of the statute of limitations as to her until she was 21 when it was tolled until age 21 for minors under the age of 18 who were the victims of malpractice. Id. at 898. In rejecting the plaintiff's argument that strict scrutiny should be applied to the statute of limitations that otherwise barred her claims, the Court found that the statute did not "impinge upon Ms. Batek's fundamental rights" because those rights include "only basic liberties explicitly or implicitly guaranteed by the United States Constitution." Id. at 898; see also Adams, 832 S.W.2d at 903.
This Court applied the reasoning of Adams and Batek to the 10-year statute of repose for architects, engineers, and builders at issue in Blaske under section 516.097. Blaske upheld the statute of repose after reaffirming that persons claiming personal injury or property damage due to defects in improvements on real property do not allege violation of a fundamental right. 821 S.W.2d at 829. The Court found that the statute of repose easily met the rational basis test. Id. at 829-30.
The Phillipses alternatively argue that, even if their right to bring suit is not otherwise fundamental, medical malpractice victims generally are a suspect class. But, as this Court noted in Mahoney v. Doerhoff Surgical Services, Inc.:
807 S.W.2d 503, 512 (Mo. banc 1991) (internal citations and emphasis omitted). For these reasons, Mahoney rejected the argument that medical malpractice claimants were a suspect class entitled to strict scrutiny
Blaske, 821 S.W.2d at 829; accord Batek, 920 S.W.2d at 898 ("Further, this Court has previously and repeatedly rejected the argument that victims of medical malpractice are members of a suspect class").
The Phillipses argue that medical malpractice victims, nonetheless, should be considered a suspect class because the application of the statute of repose disproportionately affects the poor, disabled, and elderly because they are less likely to have good or frequent medical care and so are less likely to discover the foreign object within the 10-year repose period. Yet the Phillipses do not develop this argument by citing to any case holding that the elderly or poor are a suspect class in any context, much less in regard to their right to bring medical malpractice actions. Moreover, Ms. Ambers-Phillips herself does not claim she was unable to learn of the foreign objects left in her body because she was poor, elderly, or disabled. This argument is of no assistance.
For these reasons, the Phillipses have failed to show that they fall within a traditionally suspect class or that they are burdened with disabilities or a history of discrimination that entitles them to extraordinary protection. Neither have they shown that the right of access to open courts guarantees them the right to bring suit free of the limitations imposed by a statute of repose. Consequently, as in Blaske, Adams, Batek and similar cases, this Court applies a rational basis test in determining whether the statute of repose contained in section 516.105 violates their equal protection rights. The rational basis test "is offended only if the classification rests on grounds wholly irrelevant to the achievement of the state's objective." Mahoney, 807 S.W.2d at 512. Under the rational basis test, this Court will uphold the law if it is "rationally related to a legitimate state interest." Id.; accord Batek, 920 S.W.2d at 898-99.
The Phillipses argue that the statute of repose does not pass the rational basis test because it arbitrarily and irrationally discriminates against certain victims
The Missouri Constitution mandates that the legislature "shall not pass any local or special law ... for limitation of civil actions." Mo. Const. art. III, § 40(6). The Phillipses argue that the statute of repose at issue here is a special law because it applies only to malpractice victims who have foreign objects left in their body.
This Court has defined special laws as those that "include[] less than all who are similarly situated ..., but a law is not special if it applies to all of a given class alike and the classification is made on a reasonable basis." Blaske, 821 S.W.2d at 831 (internal quotation marks omitted). This test for whether a law is a special law is similar to the test for determining whether a law violates the equal protection clause: if a classification is made on a reasonable basis or applies to all in a given class, then it is not an improper special law. See id. at 831-32.
In Batek, this Court rejected a similar "special law" objection to a statute of limitations for medical malpractice claims that began to run at age 18 years for persons who were 18 years or older at the time of the tortious conduct, but which began to run only at age 21 years for those who were younger than age 18 years at the time of the wrong. Ms. Batek was 20 years old at the time of the tort. This Court held that:
920 S.W.2d at 899 (internal citation omitted).
Similarly, Blaske rejected the argument that a statute of repose designated for building designers and builders was an
Similarly, here, as noted earlier, the legislature had a reasonable basis to impose a 10-year statute of repose when they adopted a discovery rule for medical malpractice actions involving foreign objects. The question for this Court is not whether it believes that not adopting a statute of repose would be better or fairer, but whether adoption of the repose period for foreign object suits draws a distinction without rational basis. It was not irrational for the legislature to balance a victim's right to discover his or her injury with a defendant's right to closure and to determine that 10 years was the outside limit for discovery of a cause of action for leaving a foreign object in a patient's body.
The Phillipses lastly allege that the statute of repose in section 516.105 violates the provision of the Missouri Constitution guaranteeing that "no person shall be deprived of life, liberty or property without due process of law." Mo. Const. art. I, § 10. In effect, they argue that the section 516.105 violates the due process clause because an individual has a vested property interest in a cause of action that has arisen that cannot be divested by a statute of repose before the person has discovered the foreign object's existence and has had the opportunity to file suit. This argument confuses statutes of limitations with statutes of repose. As discussed earlier, while a statute of limitation allows a cause of action to accrue and then blocks the claim if the suit is not filed within a legislatively determined time period, a statute of repose "eliminates the cause of action altogether after a certain period of time following a specified event," with the specified event in this case being the alleged medical malpractice. Blaske, 821 S.W.2d at 834. Therefore, "the cause of action is eliminated before the plaintiffs' injury and thus before plaintiffs' cause of action accrues." Id. (emphasis added). As Blaske recognized, because the plaintiff's claim is barred by the statute of repose before the claim accrues, the plaintiff never acquires a vested property right to which due process could apply. Id. For these reasons, the statute of repose in section 516.105 did not violate the Phillipses' due process rights.
For the reasons stated above, the judgment is affirmed.
Russell, C.J., Breckenridge, Fischer, Draper and Wilson, JJ., concur;
Teitelman, J., dissents in separate opinion filed.
Richard B. Teitelman, Judge, dissenting.
The principal opinion holds that the legislature is free to extinguish Ms. Ambers-Phillips' cause of action for the negligent infliction of bodily injury even when, as in this case, it was practically impossible for her to discover that foreign objects had been left in her body until well after a 10-year period of repose. While the Missouri Constitution vests the General Assembly with expansive legislative authority, the people of Missouri also expressly reserved their right to seek a "certain remedy" for their injuries. As applied to Ms. Ambers-Phillips, practical effect of the 10-year
The principal opinion reasons, consistent with prior case law, that article I, section 14 does not guarantee access to the courts once a statute of repose extinguishes the cause of action. In other words, article I, section 14 provides no substantive limitation on the legislature's authority to extinguish Ms. Ambers-Phillips' cause of action for the negligent infliction of bodily injury. This rationale is, as the principal opinion notes, supported by this Court's jurisprudence. This rationale is not, however, compelled by the text of article I, section 14, which provides:
For purposes of this case, the operative clause is that there shall be "certain remedy afforded for every injury to person...." While this Court has held that article I, section 14 limits legislative authority to arbitrarily or unreasonably bar individuals or classes of individuals from accessing the courts to enforce recognized causes of action for personal injury, Kilmer v. Mun, 17 S.W.3d 545, 549 (Mo. banc 2000), this Court has not recognized that the text of the "certain remedy" clause positively guarantees a right to a remedy. The legislative prerogative to enact statutes dealing with specific policy concerns is consistent with and not unduly hampered by recognizing that the people of Missouri, by including the "certain remedy" clause in their Constitution, expressly reserved their right to some form of an adequate legal remedy for bodily injury.
In addition to the text of article I, section 14, the nature of the open courts provision supports the conclusion that there is some substance behind it. This Court has characterized article I, section 14 as a "second due process clause to the state constitution." Goodrum v. Asplundh Tree Expert Co., 824 S.W.2d 6, 10 (Mo. banc 1992). The due process clause has both a procedural and substantive component. Doe v. Phillips, 194 S.W.3d 833, 842 (Mo. banc 2006). Under a due process analysis, "[n]o one would contend that a law of a State, forbidding all redress by actions at law for injuries to property, would be upheld in the courts of the United States, for that would be to deprive one of his property without due process of law." Poindexter v. Greenhow, 114 U.S. 270, 303, 5 S.Ct. 903, 29 L.Ed. 185 (1885). If the state cannot deny a remedy for injuries to property, then surely it cannot deny a remedy for a negligently inflicted bodily injury without violating the specific constitutional right to a "certain remedy" for "every injury to person."
Finally, the existence of a substantive component within the certain remedy clause is confirmed by the case law from other states with constitutional provisions similar to Missouri's open courts provision. At least 39 state constitutions have a similar open courts provision. David Schuman, The Right to a Remedy, 65 Temp. L.Rev. 1197, 1201 (1992). Many of these states "apparently recognize the doctrine of a substitute remedy, or quid pro quo, to justify legislative change." Thomas R. Phillips, The Right to a Constitutional Remedy, 78 N.Y.U. L.Rev. 1309, 1335 (2003). The requirement of an adequate substitute remedy recognizes that a meaningful state constitutional guarantee of a certain remedy for bodily injury must include some minimal substantive guarantee of a reasonably accessible legal remedy for
While there may be perfectly good reasons to adopt statutes of repose in some cases, the facts of this case illustrate the problem of redefining individual constitutional rights according to political whim. This is not a case about defective building design, an inaccurate real estate survey or questionable legal advice. This is not a case about a purely financial loss in which the parties are better off by writing it off. This is not a case where the passage of time raises doubts about how Ms. Ambers-Phillips was injured. Instead, this is a case about the violation of bodily integrity and the right to have some practically available remedy for a bodily injury that no one disputes. If the legislature can take that away, then the textual guarantee of a "certain remedy afforded for every injury to person" is not an individual constitutional right but is, instead, a privilege subject to legislative repeal.
I would hold that the 10-year statute of repose in section 516.105 is unconstitutional as applied to Ms. Ambers-Phillips because the statute bars her from asserting a recognized cause of action for bodily injury before she possibly could have discovered her injury. The judgment should be reversed and the case remanded to permit Ms. Ambers-Phillips to exercise her constitutional right to seek a remedy for her injury.
927 A.2d at 105 (internal citation omitted).
568 S.W.2d 525, 530 (Mo. banc 1978); see also Adams, 832 S.W.2d at 903.