Nykorchuck v. Henriques, 78 N.Y.2d 26 (1991)
The continuous treatment doctrine tolls the statute of limitations in medical malpractice cases only when there is an established course of treatment for the specific condition that gives rise to the lawsuit, not merely a continuing relationship between physician and patient.
Summary
Diane Nykorchuck sued Dr. Henriques for medical malpractice, alleging failure to properly diagnose and monitor a lump in her breast, which was ultimately diagnosed as cancer. The suit was filed more than 2.5 years after the last appointment related to her endometriosis, the prior condition Henriques treated. Nykorchuck argued the continuous treatment doctrine tolled the 2.5-year statute of limitations. The court held that the doctrine was inapplicable because the alleged negligence related to her breast condition, for which no continuous treatment was established. The court emphasized that a continuing doctor-patient relationship or the continuing nature of a diagnosis, without an actual course of treatment, is insufficient to invoke the doctrine.
Facts
Diane Nykorchuck consulted Dr. Henriques starting in 1974 for infertility problems due to endometriosis, which he treated over several years, including surgery in April 1982.
During a July 1979 visit, Nykorchuck mentioned a lump in her right breast. Dr. Henriques examined it and allegedly said it was noncancerous fibrocystic disease, stating, “we will have to keep an eye on it.”
Lumps in both breasts were noted during a pre-surgery examination in April 1982, but no further evaluation was conducted at that time.
After the surgery, Nykorchuck saw Dr. Henriques three times until September 1983 for post-operative care and estrogen replacement medication adjustments.
Dr. Henriques renewed prescriptions for Nykorchuck in 1984 and June 1985.
In December 1985, Nykorchuck scheduled an appointment due to enlargement of the breast mass.
In January 1986, Dr. Henriques examined her and immediately referred her to an oncologist, who diagnosed breast cancer.
Procedural History
Nykorchuck commenced the medical malpractice action in December 1987.
The Supreme Court denied the motion to dismiss, finding questions of fact regarding the continuous treatment doctrine.
The Appellate Division reversed, holding the doctrine inapplicable because Nykorchuck failed to show Dr. Henriques undertook treatment for her breast condition.
The New York Court of Appeals affirmed the Appellate Division’s decision.
Issue(s)
Whether the continuous treatment doctrine applies to toll the statute of limitations in a medical malpractice case when the alleged malpractice concerns a failure to treat a specific condition (breast lump) where the doctor-patient relationship existed primarily for treatment of a different condition (endometriosis) and where examinations of the untreated condition were infrequent and isolated.
Holding
No, because the continuous treatment doctrine requires an established course of treatment for the specific medical condition giving rise to the lawsuit, and isolated examinations do not constitute such a course of treatment when the primary treatment is for a separate condition. The court stated, “While the failure to treat a condition may well be negligent, we cannot accept the self-contradictory proposition that the failure to establish a course of treatment is a course of treatment.”
Court’s Reasoning
The court emphasized that the continuous treatment doctrine tolls the statute of limitations only when the treatment is continuous and related to the same original condition or complaint. CPLR 214-a explicitly requires continuous treatment “for the same illness, injury or condition which gave rise to the…act, omission or failure complained of.”
The court found that the treatment for endometriosis was a separate medical condition, and there was no alleged connection between that treatment and the breast condition. The court reasoned that the isolated breast examinations, only one of which was performed by Dr. Henriques during the relevant period, did not establish a course of continuous treatment for the breast condition, citing Davis v. City of New York, 38 N.Y.2d 257. The court stated the examinations were “discrete and complete” and separated by a significant time.
The court stated that applying the continuous treatment doctrine in this case would fundamentally extend and alter it. The gravamen of the claim was the failure to establish a course of treatment, not negligent acts or omissions during an existing course of treatment.
The court held: “In the absence of continuing efforts by a doctor to treat a particular condition, none of the policy reasons underlying the continuous treatment doctrine justify the patient’s delay in bringing suit.”