In Re: Medical Review Panel Proceeding of Donna M. Hickman

STATE OF LOUISIANA
COURT OF APPEAL, THIRD CIRCUIT

14-779

IN RE: MEDICAL REVIEW PANEL PROCEEDING OF DONNA M.
HICKMAN

**********

APPEAL FROM THE
NINTH JUDICIAL DISTRICT COURT
PARISH OF RAPIDES, NO. 247,430
HONORABLE HARRY F. RANDOW, DISTRICT JUDGE

**********

JOHN E. CONERY
JUDGE

**********

Court composed of John D. Saunders, Elizabeth A. Pickett, and John E. Conery,
Judges.

AFFIRMED.

James L. Carroll
Mixon & Carroll, PLC
Post Office Drawer 1619
Columbia, Louisiana 71418
(318) 649-9284
COUNSEL FOR PLAINTIFF/APPELLANT:
Donna M. Hickman

Victor H. Sooter
Sooter & Associates
Post Office Box 1671
Alexandria, Louisiana 71309
(318) 448-8301
COUNSEL FOR DEFENDANT/APPELLEE:
Angela H. Moreau, M.D.

Eugene J. Sues
Gold, Weems, Bruser, Sues & Rundell
Post Office Box 6118
Alexandria, Louisiana 71307-6118
(318) 445-6471
COUNSEL FOR DEFENDANT/APPELLEE:
Paul Smith, M.D.

Matthew J. Ungarino
Ungarino & Eckert L.L.C.
3850 North Causeway Boulevard, #1280
Metairie, Louisiana 70002
(504) 836-7564
COUNSEL FOR DEFENDANT/APPELLEE:
Christus St. Frances Cabrini Hospital

CONERY, Judge.

Donna Hickman (Ms. Hickman) appeals the trial court’s judgment which

granted a peremptory exception of prescription and dismissed her medical

malpractice action against Christus St. Frances Cabrini Hospital (Cabrini), Dr. Paul

Smith, and Dr. Angela H. Moreau (hereafter sometimes referred to as Health Care

Providers). For the following reasons, we affirm.

FACTS AND PROCEDURAL HISTORY

Ms. Hickman’s was injured in a one-car rollover accident which occurred on

January 21, 2012. She was taken to the Emergency Room of Cabrini, where she

was examined by the Emergency Room physician, Dr. Moreau. Dr. Moreau

ordered a CT1 scan of her face, head, abdomen, and back to determine if she had

any internal injuries or broken bones. The results of the CT scans were reviewed

by Dr. Smith, the radiologist at Cabrini, who noted no evidence of degenerative

disease or fracture. Ms. Hickman complained of pain in the lower mid-section of

her back to Dr. Moreau and was released after approximately four hours with

medication for pain and sutures in a head wound. Dr. Moreau recommended that

she follow up with Dr. Amy Griffin, Ms. Hickman’s primary care physician, for

further evaluation. Ms. Hickman had no subsequent contact with Dr. Moreau or

Dr. Smith after her treatment in the emergency room at Cabrini.

On January 31, 2012, ten days after the accident, Ms. Hickman, as instructed

by Dr. Moreau, followed up with Nurse Practitioner Tracy Lyons at the Griffin

Family Medicine Clinic (Griffin Clinic), the office of her primary care physician,

Dr. Amy Griffin. Ms. Hickman had her sutures removed and discussed with Nurse

1
A CT scan is x-ray computed tomography, which is a technology which produces
virtual slices of the scanned object. This allows the user to see inside without cutting.

Practitioner Lyons “how bad her back was hurting.”2 Based on their discussion,

Nurse Practitioner Lyons wrote a letter stating that Ms. Hickman “needed to have

an MRI done.” Ms. Hickman indicated when questioned in her deposition that her

back pain was, “Severe. Very painful.” Due to the severity of Ms. Hickman’s pain,

Nurse Practitioner Lyons prescribed additional pain medication.

At the January 31, 2012 visit, Nurse Practitioner Lyons and Ms. Hickman

discussed the necessity for an MRI.3 Ms. Hickman testified in her deposition that

she understood that the purpose of the MRI was, “To check that area of my back to

see if there was a problem.” Additionally, when asked about the MRI in her

deposition, “To see if something had been missed by --Dr. Moreau; is that

correct[,]” Ms. Hickman responded, “Right, or -- right.”

On February 27, 2012, Ms. Hickman had an orthopedic consult with Dr.

David Bernard at the Huey P. Long Medical Center, and Dr. Bernard ordered an

MRI for Ms. Hickman that same day. On February 27, 2012, the radiologist, Dr.

Joe Rankin, called Ms. Hickman after he had read her MRI. He told her she had a

compression fracture at L-1 and recommended that she see an orthopedist. Ms.

Hickman testified that Dr. Rankin “first [asked what] I did. I told him. And he

said, well, you’ve got a problem at this location and he said you need to – to get in

to see a doctor. He said I don’t know what they will -- what route they’ll take, but

you need to get in to see a doctor.”

Ms. Hickman called Nurse Practitioner Lyons and told her the MRI revealed

2
Ms. Hickman’s deposition was taken on January 21, 2014. After the first exception of
prescription was filed by Dr. Smith on March 12, 2014, Ms. Hickman, on March 26, 2014,
completed an errata sheet, which contradicted some of her previous testimony. The deposition
and errata sheet were admitted into evidence at the hearing on April 28, 2014.
3
An MRI or Magnetic Resonance Imaging is testing that uses radio wave energy to make
pictures of organs and structures inside the body. It can give different information than an x-ray
or CT scan.

2

a compression fracture at L-1. Ms. Hickman faxed a copy of the MRI to the

Griffin Clinic, which was forwarded, on March 5, 2012, by fax and received by

Mid-State Orthopedic and Sports Medicine Center (Mid-State). Ms. Hickman had

a medical history with Mid-State, having received treatment from her college

friend, Dr. Mark Dodson, for prior injuries.

After prevailing on Dr. Dodson for assistance, due to her lack of medical

insurance and the possibility she could not be seen by an orthopedist until October,

on April 12, 2012, Ms. Hickman was seen by Dr. Dodson at the Louisiana State

University Health Sciences Center (LSU-HSC) in Shreveport, Louisiana. Dr.

Dodson reviewed the MRI taken on February 27, 2012, and the January 21, 2012

CT scan from Cabrini. Dr. Dodson then confirmed Dr. Rankin’s diagnosis of a

compression fracture at L-1 and arranged for Ms. Hickman to be seen by Dr.

Richard McCall, an orthopedist at LSU-HSC. On August 30, 2012, Dr. McCall

performed the surgical procedure necessary to address Ms. Hickman’s

compression fracture at L-1.

On April 11, 2013, Ms. Hickman filed a petition for medical malpractice

against Dr. Moreau, Dr. Smith, and Cabrini with the Patients Compensation Fund,

(PCF). Her petition identified January 21, 2012 as the date of her negligent

treatment at Cabrini by Drs. Moreau and Smith. The petition also stated that April

12, 2012, the date of her appointment with Dr. Dodson, was when “Ms. Hickman

was informed for the first time that she had a significant compression fracture of

her lumbar spine.”

The Health Care Providers filed a peremptory exception urging the objection

of prescription in the judicial district court, which was set for hearing on April 28,

2014. The trial court, for reasons stated on the record, granted the peremptory

3

exception of prescription filed on behalf of the Health Care Providers on the basis

that prescription began to run on February 27, 2012 and not April 12, 2012.

February 27, 2012 was the date Ms. Hickman allegedly first discovered that she

had a compression fracture at L-1 that purportedly had not been diagnosed and

treated by Drs. Moreau and Smith at Cabrini. The trial court then dismissed with

prejudice Ms. Hickman’s claim for medical malpractice against all three Health

Care Providers in a judgment dated May 8, 2014, which Ms. Hickman now timely

appeals.

ASSIGNMENT OF ERROR

On appeal, Ms. Hickman alleges that “The Trial Court erred in finding that

the date of prescription began to run on February 27, 2012 instead of the date that

HICKMAN saw Dr. Dodson on April [12,] 2012.”

LAW AND ANALYSIS

Burden of Proof

Ms. Hickman filed her application for a medical review panel with the PCF

on April 11, 2013. In a medical malpractice action, this request serves as the initial

petition and suspends prescription from running. In re Medical Review Panel for

Claim of Moses, 00-2643 (La. 5/25/01), 788 So.2d 1173.

Louisiana Revised Statutes 40:1299.39.1(B)(2)(a) 4 allows a health care

provider, named in a petition, to bring a La.Code Civ.P. art. 927(6) exception of

4
Louisiana Revised Statutes 40:1299.39.1(B)(2)(a) provides:

The state or a person, against whom a claim has been filed under
the provisions of this Part, may raise peremptory exceptions of no right of
action pursuant to Code of Civil Procedure Article 927(6) or any
exceptions or defenses available pursuant to R.S. 9:5628 in a court of
competent jurisdiction and proper venue at any time without need for
completion of the review process by the state medical review panel.

4

prescription in a court of competent jurisdiction and venue, without regard to

“whether the medical review panel process is complete.” Moses, 788 So.2d at

1177.

When an exception of prescription is urged, the normal procedure requires

that the burden of proof rest with the mover, in this case, the Health Care Providers.

“However, when the face of the petition reveals that the plaintiff’s claim has

prescribed, the burden shifts to the plaintiff to demonstrate prescription was

suspended or interrupted. Lima v. Schmidt, 595 So. 2d 624 (La.1992).” Id. at 1177.

In this case, the alleged malpractice occurred on January 21, 2012, the date

of the one-car rollover accident and Ms. Hickman’s emergency room visit at

Cabrini. However, Ms. Hickman’s petition with the PCF was not filed until April

11, 2013. Thus, the claim appears to be prescribed on its face. However, in

Campo v. Correa, 01-2707, p. 9 (La. 6/21/02), 828 So.2d 502, 509, the supreme

court stated:

[A] petition should not be found prescribed on its face if it is brought
within one year of the date of discovery and facts alleged with
particularity in the petition show that the patient was unaware of
malpractice prior to the alleged date of discovery and the delay in
filing suit was not due to willful negligent or unreasonable action of
the patient.

The petition filed by Ms. Hickman with the PCF on April 11, 2013,

specifically states that April 12, 2013 was when “Ms. Hickman was informed for

the first time that she had a significant compression fracture of her lumbar spine.”

Therefore, the petition is not prescribed on its face under the definition provided by

the supreme court in Campo, and the burden of proof remains with the Health Care

Providers. We must make a determination of whether Ms. Hickman knew or

should have known about her cause of action before April 12, 2012, the date she

5

had her first appointment with Dr. Dodson, who compared the CT scan from

Cabrini and the MRI and confirmed the compression fracture at L-1.

Standard of Review

Evidence was introduced at the hearing on the Health Care Providers’

peremptory exception of prescription. When evidence is introduced at a hearing:

[T]he district court’s findings of fact are reviewed under the manifest
error-clearly wrong standard of review. Stobart v. State, Through
DOTD, 617 So.2d 880,992 (La.1993). If the findings are reasonable
in light of the record reviewed in its entirety, an appellate court may
not reverse even though convinced that had it been sitting as the trier
of fact, it would have weighed the evidence differently. Id. at 882-83.

Carter v. Haygood, 04-646, p. 9 (La. 1/19/05), 892 So.2d 1261, 1267.

Exception of Prescription Analysis

Louisiana Revised Statutes 9:5628(A) provides the starting point for our

analysis of the Health Care Providers’ peremptory exception of prescription:

A. No action for damages for injury or death against any physician,
chiropractor, nurse, licensed midwife practitioner, dentist,
psychologist, optometrist, hospital or nursing home duly licensed
under the laws of this state, or community blood center or tissue bank
as defined in R.S. 40:1299.41(A), whether based upon tort, or breach
of contract, or otherwise, arising out of patient care shall be brought
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.

In Carter, the supreme court reiterated its analysis of the application of

La.R.S. 9:5628 to the question of prescription. The second portion of the analysis

is applicable to the facts of this case and is known as the “discovery rule.”

Second, in cases involving damages that are not immediately apparent,
a discovery exception to the general rule is codified. The discovery
exception embodied in Section 5628 is a codification of the fourth
category of contra non valentem for cases in which the cause of action

6

is not immediately knowable. Under this discovery rule, such actions
prescribe one year from the date of discovery of the alleged act,
omission or neglect.

Carter, 892 So.2d at 1267 (quoting Moses, 788 So.2d at 1178-79).

Cases dealing with the issue of prescription in a medical malpractice case

clearly instruct:

[T]hat each case must be decided on its own peculiar facts. The law
does not require that a patient be informed by an attorney he has a
medical malpractice action before prescription begins to run.
Likewise, it is not a requirement that a patient be informed by a
medical practitioner of possible malpractice before prescription will
begin to toll.

Parker v. Dr. X, 97-841, p.4 (La.App. 3 Cir. 12/10/97), 704 So. 2d 373, 375; See

also Lambert v. Metrailer, 485 So.2d 69 (La.App. 1 Cir.1986), writ denied, 488

So.2d 1023 (La.1986).

In Braud v. Cenac, 03-1696 (La.App. 3 Cir.7/14/04) 879 So.2d 896, writ

denied, 04-2101 (La. 11/15/04), 887 So.2d 484, a panel of this court summarized

the factors that should be considered in this court’s determination of when a

prescriptive period begins to run, when a patient, such as Ms. Hickman, does not

immediately recognize that her condition may have been related to treatment or in

this case, the lack thereof:

Louisiana Revised Statute 9:5628’s one-year prescriptive
period “commences running on the date the injured party discovers or
should have discovered the facts upon which his cause of action is
based.” In other words, constructive knowledge is sufficient to trigger
the running of prescription, and the plaintiff is “deemed to know that
which he could have learned through reasonable diligence.” The heart
of the inquiry is the reasonableness of the plaintiff’s action or
inaction. This inquiry requires consideration of her education,
intelligence, and the gravity of her condition, as well as the
defendant’s conduct. Reasonability is a factual determination which
an appellate court cannot disturb, absent a finding of manifest error.

Id. at 902 (footnotes omitted).

7

In its reasons given on the record at the close of the hearing, the trial court

stated:

Certainly I think that any of us that go into a hospital or doctor’s
office and we are x-rayed we expect that that doctor that looks at that
x-ray reads it correctly. I don’t think that we expect our doctors not to
be able to see a fracture. Or to diagnose whatever is purpose of that
radiology exam and everything. I just make that comment, I don’t
know whether malpractice has, in fact, been committed here but I
hope any time I go in that my doctor is not going to be missing that. If
I was just confronted today with the fact that Ms. Hickman after
having her accident and being seen at Cabrini Hospital on January the
twenty-first then followed up on January the thirty-first with
continuing and, in fact, increased pain and it was recommended to her
that she have an MRI I don’t think that I would find this case as
challenging as I do with a follow up visit or conversation with the
radiologist, Dr. Rankin on February the twenty-seventh when he
advised Ms. Hickman that she had a fracture - a compression fracture
at L-1 and that she needed to see an [orthopedist]. I’m assuming that
she had had no intervening incident that could’ve resulted in that and
so that the only thing that she could possibly think back to was her
automobile accident and the fact that she was initially told by the
Cabrini Hospital doctors that they didn’t find any evidence of any
fractures or whatever. And so I think at that point, I think that that is
the defining point in this case and I think that it is reasonable for this
court to find that at that time Ms. Hickman had constructive
knowledge as that term of art is used in our jurisprudence. And in part
is captured in our statute. And so for those reasons, I’m going to grant
the motion for summary judgment and ask Mr. Sues and the others on
the part of the hospital and the doctors to prepare a judgment
accordingly.

MR. SUES: Your Honor, could I correct one thing?

THE COURT: Yes.

MR. SUES: Your Honor said grant the motion for summary judgment,
it’s actually a peremptory exception of prescription.

THE COURT: I’m sorry. You are right. A peremptory exception of
prescription. Thank you.

The trial court found factually that on February 27, 2012, Ms. Hickman,

after her discussion with Dr. Rankin and review of her MRI, had the necessary

constructive knowledge required to begin the running of prescription on her

8

medical malpractice claim against the Health Care Providers. In reviewing the trial

court’s findings, our analysis must include the “reasonableness of the plaintiff’s

action or inaction.” Braud, 879 So.2d at 903.

Braud instructs that this court is required to take into consideration both Ms.

Hickman’s “education and intelligence.” Id. at 903. The record reflects that Ms.

Hickman obtained her undergraduate college degree from Louisiana College.

After college she worked as a drug representative for at least three pharmaceutical

companies, where she received training in the risks and benefits of the companies’

medications. She also received training in human anatomy and education

involving the “legal aspects” of the medications, which would have included the

potential for litigation from the side effects of the medications. As a result of her

college education and exposure to the medical and legal field, Ms. Hickman

possessed both the intelligence and life experiences necessary to evaluate her

medical/legal situation.

As would be expected of an individual with her background and knowledge,

Ms. Hickman followed up with Dr. Griffin’s office approximately ten days after

the rollover accident, as instructed by Dr. Moreau, to have her sutures removed.

Ms. Hickman’s deposition testimony indicates that the pain in her back had not

improved and was “severe,” at that initial visit with Nurse Practitioner Lyons on

January 31, 2012. Based on Ms. Hickman’s continuing back pain issues, Nurse

Practitioner Lyons ordered an MRI and prescribed additional medication. The

record before the trial court indicated that Ms. Hickman continued to have

significant pain until her condition was eventually addressed by surgery.

On February 27, 2012, approximately five weeks after the rollover accident,

Ms. Hickman was referred by the Griffin Clinic to Dr. Bernard. Dr. Bernard

9

ordered an MRI for the same day. Also on February 27, 2012, Dr. Rankin read the

MRI and called Ms. Hickman to report the results. Dr. Rankin informed Ms.

Hickman of the compression fracture at L-1, and recommended that she see an

orthopedist.

At this juncture, as the trial court correctly found, there had been “no

intervening accident that could’ve resulted in that and so that the only thing that

she could possibly think back to was her automobile accident and the fact that she

was initially told by the Cabrini Hospital doctors that they didn’t find any evidence

of any fractures or whatever.”

The trial court termed the February 27, 2012 call from Dr. Rankin to Ms.

Hickman, confirming her compression fracture at L-1, as the “the defining point in

the case.” The trial court found it was “reasonable . . . to find that at that time Ms.

Hickman had constructive knowledge as that term of art is used in our

jurisprudence.”

The referral of a patient to another physician can constitute the constructive

knowledge necessary to commence the running of the one year prescriptive period.

In Amos v. Crouch, 46,456 (La.App. 2 Cir. 6/29/11), 71 So.3 1053, Mr. Amos last

consulted with his employer, Dr. Crouch, about his rectal bleeding on January 3,

2000. Dr. Crouch had been treating him for hemorrhoids and did not refer Mr.

Amos to a specialist or for any additional testing. At the urging of his family and

due to his own concerns, Mr. Amos saw a physician at the Green Clinic in Ruston,

Louisiana on January 11, 2000. The examination at that appointment revealed a

mass that appeared to be cancer and was confirmed by other tests. Mr. Amos was

diagnosed with colorectal cancer and began treatment, which included radiation,

chemotherapy, and surgery.

10

Mr. Amos filed his petition with the PCF on April 6, 2001, and alleged that

Dr. Crouch had committed medical malpractice by failing to recommend and

conduct the proper diagnostic testing. The medical review panel found the

standard of care would have been to require more testing, but also found the issue

of a breach was subject to a resolution of “material issues of fact.” Amos, 71 So.3d

at 1054.

Suit was filed on April 26, 2003, and Mr. Amos died on May 3, 2003. His

surviving children were substituted as plaintiffs in both their father’s malpractice

suit and their own wrongful death claim. The defendants filed an exception of

prescription after a summary judgment was granted by the trial court and reversed

by the supreme court.5 The defendants claimed that January 11, 2000, the date that

Mr. Amos was diagnosed with cancer, marked the date prescription began to run.

The plaintiffs claimed that May 1, 2000, when Mr. Amos called Dr. Crouch and

asked her to continue his treatment and she terminated the doctor/patient

relationship, was the date that began the tolling of prescription. Id. at 1055.

The trial court granted the defendant’s exception of prescription and found

that prescription began to run on January 11, 2000, when Mr. Amos cancer was

confirmed. A panel of our sister court affirmed the lower court and found that the

trial court’s determination that “Mr. Amos had notice enough to excite attention, to

put him on guard and call for inquiry when his cancer was diagnosed on January

11, 2000,” was not “clearly in error or manifestly wrong.” Id at 1057.

Counsel for Ms. Hickman argued at the hearing and on appeal that she had

experienced previous back injuries and could not have determined with certainty

5
Amos v. Louisiana Medical Mutual Insurance Company, 41,302 (La.App.2 Cir. 8/4/6),
936 So.2d 875.

11

that the compression fracture at L-1 was the result of the accident and misdiagnosis

by the Health Care Providers.

However, as argued at the hearing and on appeal by counsel for the Health

Care Providers, Ms. Hickman’s deposition clarified this issue for the trial court:

Q Did you have any back complaints at Cabrini?[6]

A Yes, sir.

Q What part of your back?

A The lower mid section.

Q Was that some of the same area that you’d previously had complaints
about?

A No, sir.

Our courts have consistently held that “Prescription does not begin to run

against a party who is ignorant of the pertinent facts, as long as the ignorance is not

willful, negligent or unreasonable.” Parker, 704 So.2d at 375; see also Griffin v.

Kinberger, 507 So.2d 821 (La.1987). Parker further instructs:

On the other hand, when the facts show the injured party “had
knowledge of facts strongly suggestive that an untoward condition or
result may be the result of improper treatment and there is no effort by
health care providers to mislead or cover up information which is
available to plaintiff through inquiry or professional medical or legal
advice, then the facts and cause of action are reasonably knowable to
the plaintiff” for the purposes of the one year prescriptive period;
plaintiff’s inaction for more than one year under such circumstances is
not reasonable.

Parker, 704 So.2d at 375 (citing Maung-U v. May, 556 So.2d 221 (La.App 2 Cir.

1990), writ denied, 559 So.2d 1385 (La.1990).

Based on the record before us, we find that Ms. Hickman had the necessary

constructive knowledge to begin the tolling of the one year prescriptive period on

6
This question is in reference to her treatment received in the Cabrini Emergency Room
after Ms. Hickman’s one car accident on January 21, 2012.

12

February 27, 2012, and thus, her claim for medical malpractice against the Health

Care Providers was prescribed when her petition was filed with the PCF on April

11, 2013. Considering Ms. Hickman’s education and intelligence, her continuing

pain from the time of the January 21, 2012 rollover accident, the confirmation by

Dr. Rankin after reviewing the MRI on February 27, 2012, that she had a

compression fracture at L-1, without any intervening incident, and the fact that she

had not previously suffered back pain at this location, we must find that the trial

court was not manifestly erroneous in finding that Ms. Hickman knew, on

February 27, 2012, that the Health Care Providers had failed to properly diagnose

her back injury on January 21, 2012. The judgment of the trial court dismissing

Ms. Hickman’s petition filed more than one year later on April 11, 2012 is

affirmed.

CONCLUSION

Accordingly, for the reasons stated, the judgment of the trial court is

affirmed. All costs of this appeal are assessed against Donna M. Hickman.

AFFIRMED.

13