In Re: Medical Review Proceedings Cheryl D. Armenio

Judgment rendered November 19, 2025.
Application for rehearing may be filed
within the delay allowed by Art. 2166,
La. C.C.P.

No. 56,441-CW

COURT OF APPEAL
SECOND CIRCUIT
STATE OF LOUISIANA

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IN RE: MEDICAL REVIEW PROCEEDINGS
CHERYL D. ARMENIO

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On Application for Writs from the
Twenty-Sixth Judicial District Court for the
Parish of Bossier, Louisiana
Trial Court No. 173,927

Honorable Michael Nerren, Judge

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BRADLEY, MURCHISON, KELLY & Counsel for Applicant,
SHEA, LLC Twyla C. Hurst
By: Dwight C. Paulsen, III
Phiyen H. Phan

CHERYL D. ARMENIO In Proper Person,
Respondent

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Before PITMAN, STONE, and MARCOTTE, JJ.

PITMAN, C. J.

Applicant Twyla C. Hurst sought supervisory review of the trial

court’s ruling denying her exception of prescription in this suit for medical

malpractice. The writ was granted to docket. For the following reasons, the

writ is granted, the judgment of the trial court is reversed, and the exception

of prescription is sustained.

FACTS

Cheryl Armenio, proceeding pro se, filed a medical malpractice

complaint on April 4, 2023, and alleged that Twyla Hurst was her primary

care doctor for eight years and that during that time, Hurst tested her for

Hepatitis C because of elevated liver enzymes, but, on more than one

occasion, told her that she did not have the condition. She alleged that Hurst

referred her to a gastroenterologist (“G.I.”) and that on April 21, 2022, she

was diagnosed with chronic liver disease as a result of untreated Hepatitis C.

The Patient’s Compensation Fund (“PCF”) advised her that her complaint

was deficient because she failed to request formation of a medical review

panel, failed to provide the dates of the alleged malpractice and failed to

return the corrected panel request within 45 days.

On May 22, 2023, Armenio filed a supplemental complaint alleging

that Hurst was her primary care doctor from July 1, 2016, to January 31,

2022. She claimed that she asked to be tested for Hepatitis C on her first

visit, but was told she did not have it. She had received a letter from LSU

Hospital referring her to the Hepatitis C Clinic, which she told Hurst about

on September 8, 2020. Hurst told her that she did not have Hepatitis C but

asked her to sign a release form so she could get her records from LSU.

Armenio claimed she did not hear from Hurst again until January 12, 2022,

when Hurst again assured her that she did not have Hepatitis C. However,

because she did have elevated liver enzymes, Hurst referred her to a G.I.,

Amy Lewing, FNP-C, (nurse practitioner) on March 8, 2022. Armenio was

diagnosed with Hepatitis C on April 21, 2022.

The PCF again advised Armenio that her complaint was deficient

because she failed to request formation of a medical review panel and that

she needed to return the corrected panel request within 45 days. Armenio

failed to do so, and the PCF sent a second request on October 10, 2023. On

October 19, 2023, Armenio filed a supplemental complaint requesting the

formation of a medical review panel. Thereafter, the PCF notified Armenio

that Hurst was a qualified health care provider.

Armenio filed a supplement to her complaint, consisting of a May 31,

2019, clinical note from “OLSC ACC Infectious Disease”1 stating: “Patient

needs labs prior to scheduling an appointment in Hep C clinic. Unable to

contact patient via telephone; letter mailed requesting patient to call to

schedule appt.”

On October 3, 2024, Hurst filed an exception of prescription, asserting

that Armenio’s claim was prescribed because the medical malpractice

complaint was not filed within one year from the date she was diagnosed

with Hepatitis C or within one year from the date of the discovery she had

Hepatitis C and agreed to enter treatment. She attached the certified medical

records from Bossier Family Medical Clinic, Christus Highland and Ochsner

LSU.

1
This office is one at Oschner Louisiana State University, but the letterhead on
which the clinical note is written is only identified the office by initials.
2

A summary of the medical records establishes the following timeline:

• On April 25, 2017, Armenio was seen by Hurst for
hypertension, which was first diagnosed seven years earlier. No
substance abuse history was noted.

• On May 23, 2017, Hurst ordered blood work, which showed
Armenio’s AST and ALT were within normal limits. Armenio
was notified of the results by phone on May 31, 2017.

• On October 3, 2017, Armenio had a follow-up visit with Hurst
regarding hypertension, anxiety, depression and insomnia.
Hurst ordered blood work, which showed Armenio’s AST and
ALT were within normal limits. The clinic was unable to notify
Armenio of the results because she did not have a phone.

• On June 27, 2018, Armenio saw Hurst for a toothache, and
Hurst recommended that Armenio schedule an appointment
with an oral surgeon as soon as possible.

• On June 16, 2020, Armenio had a follow-up visit with Hurst
regarding hypertension, lab work and Tdap immunization.
Hurst ordered blood work, which showed Armenio’s AST and
ALT were slightly elevated. The next day, Armenio was
advised of the results and told to “avoid APAP and ETOH due
to elevated AST/ALT” and to repeat labs in three months.

• On December 16, 2020, Armenio had a follow-up visit with
Hurst regarding hypertension. Hurst ordered blood work, which
showed Armenio’s AST and ALT were elevated (higher than
the previous lab report). Hurst recommended a referral to a G.I.
clinic. However, the records contain notes that the clinic left
messages for Armenio to call back for the results on December
17 and 18, 2020.

• On December 2, 2021, Armenio went to the Emergency Room
at Christus Highland with complaints of hand pain. The record
notes that although Armenio denied any drug use, her urinalysis
was positive for methamphetamines.

• On January 11, 2022, Armenio saw Hurst with continued
complaints of hand pain. Hurst ordered blood work, which
showed Armenio’s AST and ALT continued to be elevated and
that her Rheumatoid Factor was mildly elevated. Armenio was
advised of the results on January 12, 2022, and was referred to
a G.I. specialist and a rheumatologist.

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• On March 8, 2022, Armenio was seen by Amy Lewing, NP, at
the gastroenterology clinic at Ochsner LSU. Armenio reported
no complaints or symptoms. Armenio admitted to a “long
history of illicit drug use,” but claimed she had stopped three
years prior.

• Lewing ordered lab work, which came back positive for
Hepatitis C antibodies.

• On March 9, 2022, Lewing called Armenio and left a message
notifying her of the results and that further blood work was
needed. Lewing also advised Armenio via a patient portal
message as follows:

Hi! Your Hepatitis C antibody came back positive.
This can mean two things: 1. You had a past
infection and cleared it on your own. 2. You have
an active Hepatitis C infection that needs to be
treated. I have ordered more labs that can help us
see if the infection is active. Give the clinic a call
at 626-1960 and I will tell you where to go to get
labs.

• The March 25, 2022 medical record indicates patient tested
positive for Hepatitis antibodies. The progress note from the
same date states: “Patient called clinic and [stated] she was
ready for Hep C treatment.”

• At the hearing on the exception of prescription, Armenio
established that she did not have the blood work suggested by
Lewing until April 14, 2022.

• On April 21, 2022, she went to a rheumatologist who informed
her that she had tested positive for Hepatitis C.

In the exception of prescription, Hurst argued that although Armenio

alleged that she was diagnosed with Hepatitis C on April 21, 2022, the

certified medical records establish that Armenio knew she had Hepatitis C

on March 9, 2022, when she was advised of her positive antibody test, or on

March 25, 2022, when she was prepared to begin treatment, more than one

year before the complaint was filed on April 4, 2023. Further, Hurst argued

that Armenio had constructive knowledge necessary to start the running of

prescription more than one year before the complaint was filed. Based on

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the May 31, 2019 clinical note that Armenio provided to the PCF as a

supplement to her complaint, Armenio was seeking an appointment in the

Hepatitis C Clinic almost four years before the complaint was filed. Hurst

referred Armenio to the G.I. Clinic on December 17, 2020, and January 12,

2022, based on elevated AST and ALT levels. She argued that this

information was sufficient to incite curiosity or put Armenio on guard and

call for inquiry as to her Hepatitis C status.

Armenio did not file an opposition to the exception of prescription. A

hearing was held on February 11, 2025, at which the trial court, aware that

she did not have counsel, explained certain matters concerning prescription

and then allowed her to take part in the argument. The trial court took the

matter under advisement and then signed a judgment denying Hurst’s

exception of prescription.

The trial court found that the March 9, 2022 message in Armenio’s

medical records did not commence the running of prescription because it did

not put Armenio on notice that she had been diagnosed with Hepatitis C.

Instead, the message informed Armenio that more testing was needed to

determine whether there was an active infection, which is not the same as a

diagnosis. Further, the trial court found that the March 25, 2022 progress

note did not definitively show that Armenio was diagnosed with Hepatitis C

more than one year prior to April 4, 2023, as it is unclear whether she

needed “Hep C treatment” at that time. The trial court noted that at the

hearing, Armenio stated she did not receive the additional lab work

referenced in the March 9, 2022 message until April 14, 2022, and did not

receive the results and a formal diagnosis of Hepatitis C until April 21, 2022.

Because the medical records do not show that Armenio had a definitive
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diagnosis more than one year prior to the filing of the complaint, the trial

court determined that the complaint was timely.

Hurst filed a notice of intent to seek writs from the judgment denying

the exception of prescription. However, the trial court denied the request for

a return date on the basis that the request was premature because Hurst had

already filed a motion for a new trial, which had not yet been heard or ruled

upon. Hurst filed a motion in this court to set an extended writ return date,

which was granted, and this writ was timely filed on March 17, 2025. On

May 7, 2025, this writ was granted to docket.

DISCUSSION

Hurst contends that the trial court erred in denying her exception of

prescription and argues that Armenio’s malpractice complaint is prescribed

on its face because it was not filed within one year of the dates of the alleged

malpractice, which span from July 1, 2016, to January 31, 2022. She also

contends that the complaint does not allege any delay in discovery or any

allegations relative to the reasonableness of that delay. As such, Hurst claims

that the burden should have shifted to Armenio to prove that her claim was

not prescribed. Armenio did not file an opposition in the trial court and

simply claimed that she was not diagnosed with Hepatitis C until April 21,

2022.

Hurst argues that the trial court improperly placed the burden on her

to show that Armenio had a definitive diagnosis more than one year prior to

the filing of the complaint. She contends that the trial court misapplied the

discovery rule and that the facts alleged by Armenio and the certified

medical records establish that Armenio had enough information to excite

curiosity, place her on guard and call for inquiry as to whether malpractice
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had occurred more than a year before April 4, 2023. Hurst notes that

regardless of any further testing needed to determine whether this was an

active infection or a prior infection, Armenio was specifically on notice by

March 9, 2022, that she was either presently or previously infected with

Hepatitis C. She also claims that Armenio’s documented failure to follow

her follow-up recommendations and delays in following through with the

referral to a G.I. specialist in December 2020 based on elevated liver

enzyme levels render any delay in learning of her Hepatitis C diagnosis

unreasonable.

Armenio has not filed an opposition to the writ application; and, thus,

there are no arguments to consider regarding the exception of prescription.

Our jurisprudence reflects that the standard of review of a judgment

pertaining to an exception of prescription turns on whether evidence is

introduced at the hearing of the exception. La. C.C.P. art. 931 expressly

allows “evidence [to] be introduced to support or controvert [a peremptory

exception] pleaded, when the grounds thereof do not appear from the

petition.” Mitchell v. Baton Rouge Orthopedic Clinic, L.L.C., 21-00061 (La.

10/10/21), 333 So. 3d 368. If no evidence is submitted at the hearing, the

exception must be decided upon the facts alleged in the petition with all of

the allegations accepted as true. Id. In that case, the reviewing court is

simply assessing whether the trial court was legally correct in its finding. Id.

When evidence is introduced at the hearing, a court need not accept the

allegations of the petition as true, and the lower court decisions are to be

reviewed under a manifest error-clearly wrong standard of review. Id. A

caveat to this rule is that, even when evidence is introduced, when there is

no dispute regarding material facts, the reviewing court is to apply a de novo
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standard of review and give no deference to the trial court’s legal

conclusions. Id.

A medical malpractice claim must be filed within a year of the alleged

malpractice or the discovery of the malpractice, as set forth in La.

R.S. 9:5628(A), which provides:

No action for damages for injury or death against any
physician, … arising out of patient care shall be bought unless
filed within one year from the date of the alleged act, omission,
or neglect, or within one year from the date of discovery of the
alleged act, omission, or neglect; however, even as to claims
filed within one year from the date of such discovery, in all
events such claims shall be filed at the latest within a period of
three years from the date of the alleged act, omission, or
neglect.

La. R.S. 9:5628(A) provides two periods for filing a malpractice

action−either one year from the date of the alleged act, omission or neglect,

or one year from the date of discovery of the act, omission or neglect,

provided that no more than three years have elapsed from the date of the

alleged act, omission or neglect. The second period is a codification of the

fourth category of contra non valentem that occurs where the cause of action

is not known or reasonably knowable by the plaintiff and when the damages

are not immediately apparent upon commission of the alleged malpractice.

Campo v. Correa, 01-2707 (La. 6/21/02), 828 So. 2d 502; Johnson v. Ruston

Louisiana Hosp. Co., LLC, 54,258 (La. App. 2 Cir. 8/10/22), 345 So. 3d

464, writ denied, 22-01378 (La. 11/22/22), 350 So. 3d 503.

In Campo v. Correa, supra, the Louisiana Supreme Court explained:

Prescription commences when a plaintiff obtains actual or
constructive knowledge of facts indicating to a reasonable
person that he or she is the victim of a tort. A prescriptive
period will begin to run even if the injured party does not have
actual knowledge of facts that would entitle him to bring a suit
as long as there is constructive knowledge of same.
Constructive knowledge is whatever notice is enough to excite
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attention and put the injured party on guard and call for inquiry.
Such notice is tantamount to knowledge or notice of everything
to which a reasonable inquiry may lead. Such information or
knowledge as ought to reasonably put the alleged victim on
inquiry is sufficient to start running of prescription.
Nevertheless, a plaintiff’s mere apprehension that something
may be wrong is insufficient to commence the running of
prescription unless the plaintiff knew or should have known
through the exercise of reasonable diligence that his problem
may have been caused by acts of malpractice. Even if a
malpractice victim is aware that an undesirable condition has
developed after the medical treatment, prescription will not run
as long as it was reasonable for the plaintiff not to recognize
that the condition might be treatment related. The ultimate issue
is the reasonableness of the patient’s action or inaction, in light
of his education, intelligence, the severity of the symptoms, and
the nature of the defendant’s conduct. [Internal citations
omitted.]

The law of prescription does not require that the patient be informed

by a medical practitioner or an attorney of possible malpractice before the

limitation period begins to run. Powell v. St. Francis Med. Ctr., Inc., 52,462

(La. App. 2 Cir. 2/27/19), 265 So. 3d 1184. Prescription does not run as

long as it is reasonable for a plaintiff not to recognize that the injury may be

related to treatment. Id. When a plaintiff has knowledge of facts strongly

suggestive that the untoward condition or outcome may be the result of

improper treatment and there is no effort by the health care provider to

mislead or cover up information which is available to plaintiff through

inquiry, then the cause of action is reasonably knowable to plaintiff. Id.

Inaction by a plaintiff for more than one year under such circumstances is

not reasonable. Id. The plaintiff’s ignorance of his cause of action cannot be

attributable to his own willfulness or neglect, as a plaintiff is deemed to

know what he could have learned by reasonable diligence. Johnson v.

Ruston Louisiana Hosp. Co., LLC, supra.

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Ordinarily, the party pleading prescription bears the burden of proving

that the claim has prescribed; however, when prescription is evident on the

face of the pleadings, the burden shifts to the plaintiff to show that the action

has not prescribed. Higgins v. Russell, 55,624 (La. App. 2 Cir. 5/22/24),

386 So. 3d 1236. A plaintiff is then imputed with whatever knowledge a

reasonable inquiry or investigation would reveal. In re Med. Rev. Panel of

Heath, 21-01367 (La. 6/29/22), 345 So. 3d 992. A petition is not prescribed

on its face if it is filed within one year of discovery and particularly alleged

facts show that the patient was unaware of malpractice before that date, so

long as the filing delay was not willful, negligent or unreasonable. Id.

Based on the allegations in the original and supplemental complaints,

the dates of the alleged malpractice span from July 1, 2016, to January 31,

2022, while Hurst was Armenio’s primary care doctor. The original medical

malpractice complaint, alleging a delayed diagnosis of Hepatitis C, was filed

on April 4, 2023, more than one year later. To the extent that Armenio’s

allegation that she was diagnosed with Hepatitis C on April 21, 2022,

sufficiently states the date of her discovery of the malpractice, she failed to

allege that she was unaware of the malpractice prior to that date, or provide

factual allegations regarding the reasonableness of the delay in discovery.

Thus, her complaint is prescribed on its face and the burden of proof shifted

to her to show that her claim had not prescribed. She failed to prove she

discovered the possible malpractice less than one year before the complaint

was filed and also failed to file an opposition in response to the exception of

prescription.

A definitive diagnosis is not required to start the running of

prescription, and Hurst supported her exception with medical records
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showing that Armenio had constructive notice of the possible malpractice

more than one year before the complaint was filed. Lab work showed she

had elevated liver enzymes in June 2020 and in December 2020. Hurst

recommended a referral to a G.I. clinic, but Armenio never followed up with

that recommendation until January 2022, when lab work showed even more

elevated enzyme levels. After having more lab work done, she was notified

on March 9, 2022 via voicemail and a patient portal message that she was

positive for Hepatitis C antibodies, but that additional lab work was needed

to determine if it was a past or active infection. Armenio even called the

G.I. clinic on March 25, 2022, stating she was ready for “Hep C treatment.”

These facts establish that Armenio had sufficient information to excite

her attention and put her on guard to call for inquiry as to a possible missed

diagnosis by March 25, 2022 at the latest. Thus, her malpractice complaint,

filed on April 4, 2023, was prescribed and the trial court erred in denying

Hurst’s exception of prescription. For these reasons, the assignment of error

has merit.

CONCLUSION

For the foregoing reasons, the writ filed by Applicant Twyla Hurst is

granted, and the judgment of the trial court denying the exception of

prescription is reversed, and the case is dismissed. Costs are assessed

against Respondent Cheryl D. Armenio.

WRIT GRANTED. JUDGMENT REVERSED. CASE

DISMISSED WITH PREJUDICE.

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