Charter Peachford Behavioral Health System, Inc. v. Kohout.

Citations: 504 S.E.2d 514; 233 Ga. App. 452; 98 Fulton County D. Rep. 2773; 1998 Ga. App. LEXIS 995Docket: A98A1503-A98A1506

Court: Court of Appeals of Georgia; July 15, 1998; Georgia; State Appellate Court

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In the case of Charter Peachford Behavioral Health System, Inc. et al. v. Kohout, the Georgia Court of Appeals examined issues related to malpractice and the statute of limitations concerning mental health treatment. The appeals primarily focused on the statute of limitations but were articulated differently across cases A98A1503 to A98A1506. The plaintiff, Ms. Kohout, has a documented history of mental health issues dating back to 1987, including an eating disorder, depression, suicidal ideation, and auditory hallucinations, arising from reported sexual abuse. 

In June 1990, Dr. Ann Gustin diagnosed her with multiple personality disorder (MPD) and treated her until she discontinued therapy. In August 1990, she began treatment with Dr. Donna Ulrici, who concurred with Dr. Gustin's diagnosis. Kohout alleges that during her stay at Charter Peachford Hospital from March to August 1991, the defendants, including Dr. Ulrici and others, improperly guided her therapy, leading her to adopt beliefs about having MPD and being sexually abused during satanic rituals. She claims the treatment involved flawed techniques, such as memory work and hypnosis, resulting in the recovery of "repressed" memories of abuse. 

Furthermore, from August to September 1991, she was admitted to CPC Parkwood Hospital, where she contends that her diagnosis was accepted without adequate independent evaluation. Kohout was later hospitalized multiple times at both Charter and Parkwood, during which she exhibited self-harm behaviors. The case raises significant questions regarding the appropriateness of the therapeutic interventions employed and their impact on the plaintiff's mental health.

In November 1992, the plaintiff began working as a full-time nanny for Dr. Elizabeth Goey, continuing until August 1994, followed by employment with Ms. Lauretta Russell until December 1994. The plaintiff experienced hospitalization at Parkwood from August 17 to August 19, 1994, but did not receive further treatment from the defendants, except for Dr. Ulrici, until discontinuing treatment with him in February 1995. On November 25, 1995, the plaintiff filed a complaint alleging medical malpractice related to misdiagnosis and treatment. After filing an amended complaint on March 25, 1996, which included Parkwood as a defendant, the defendants-appellants sought summary judgment based on the statute of limitations, which the trial court denied. On appeal, the court found that the statute of limitations should bar the plaintiff's action for injuries occurring before October 12, 1992, as defined by OCGA 9-3-70(1) and (2). The statute mandates that medical malpractice actions be filed within two years of the injury date. The plaintiff's claims of misdiagnosis, including assertions of sexual abuse, were deemed to have manifested at the time of the defendants' actions, indicating that damages were evident from the onset of misdiagnosis. The ruling emphasized that in misdiagnosis cases, the injury is considered to occur immediately upon the misdiagnosis, and the plaintiff's claims for mental pain and special damages stem from the initial misdiagnosis and subsequent unnecessary treatments.

The plaintiff was aware of the injury resulting from the defendant's misdiagnosis and treatment from the outset, as the diagnosis was disclosed at the time of the act. Despite later recognizing the misdiagnosis and its emotional impact, the plaintiff had prior knowledge of the alleged abuse and the misdiagnosis. The plaintiff experienced mental suffering due to the belief in the misdiagnosis, which led to familial isolation. In cases of misdiagnosis, damages are recognized as starting the statute of limitations, regardless of later understanding the medical cause. The 'discovery rule' does not apply if damages occurred concurrently with the wrongful acts, leading to the immediate accrual of the cause of action. The 'continuing tort' theory does not apply to medical malpractice claims, as it contradicts statutory intent that bars actions after five years from the negligent act, irrespective of any disabilities affecting the statute of limitations. Under OCGA 9-3-71, a statute of repose prevents any medical malpractice action after five years from the wrongful act, rendering the right of action null. If the injury is not manifest until years later, the statute of limitations begins only upon the injury’s discovery. Thus, the tort action does not commence until damages are incurred.

Discovery in tort actions is contingent upon the manifestation of damages; if no damages are evident, the statute of limitations does not commence. Georgia courts assert that in cases of continuing torts, a cause of action accrues when the plaintiff discovers, or should reasonably have discovered, both the injury and its cause. The accrual of an action can be delayed by discovery or tolled due to factors like infancy, incompetency, or fraud, but the statute of repose terminates the action five years after the negligent or wrongful act, regardless of any non-discovery or tolling circumstances. To toll the statute of limitations based on fraud or concealment, the plaintiff must provide evidence of each defendant's fraudulent actions. A plaintiff's prior knowledge of facts necessary to establish malpractice can prevent tolling, even in the presence of actual fraud. Fraud that tolls the statute must be actual and prevent the plaintiff from bringing the action. Under Georgia law, to toll the statute based on fraud, three criteria must be met: actual fraud involving moral turpitude by the defendant, concealment of the cause of action, and the plaintiff's reasonable diligence in discovering it despite the lack of timely discovery. The fraud must effectively deter the plaintiff from timely suit for tolling to apply.

Fraud must actively conceal a cause of action to prevent a plaintiff from suing, thereby tolling the statute of limitations. This concealment can involve tricks or artifices that obstruct the plaintiff's ability to investigate or obtain necessary information about the cause of action. If the claim involves constructive fraud, negligence, or breach of contract, there must be an additional act of actual fraud or intentional concealment that prevents the plaintiff from pursuing their claim. However, if the claim is for actual fraud, the statute of limitations begins upon the discovery of the fraud or when it should have been discovered through due diligence, unless a confidential relationship exists that justifies reliance on the other party’s representations.

Silence alone does not constitute actual fraud; there must be an affirmative act to conceal the cause of action. In cases involving confidential relationships, such as physician-patient, non-disclosure or concealment can amount to fraud that tolls the statute of limitations if there is intent to conceal. Evidence of intent to mislead or the existence of false representations is necessary to establish fraud. In confidential relationships, the plaintiff is entitled to rely on the information provided by the other party, and failure to disclose relevant information may toll the statute if intentional concealment is demonstrated. Each healthcare provider must be shown to have intentionally withheld information regarding wrongful conduct to effectively toll the statute of limitations.

Defendants-appellants lacked knowledge of any misdiagnosis before the lawsuit and did not intend to conceal information from the plaintiff that could establish a cause of action. A mere misdiagnosis does not constitute fraud. For fraud to be established, there must be an intentional failure to disclose negligence. The plaintiff, despite the confidential physician-patient relationship, was not prevented from recognizing the alleged negligence, as she was aware of her diagnosis and treatment choices. The plaintiff's belief in a misdiagnosis was based on the same information she previously possessed but interpreted differently. Therefore, fraud did not toll the statute of limitations against any defendant-appellant.

The relevant statutes, OCGA 9-3-73(b) and OCGA 9-3-90(a), regarding mental incompetence, require a plaintiff to be 'mentally incompetent' during the tolling period. The General Assembly did not intend to change the prior law, and mental incapacity is included in the definition of insanity. The tolling provisions of OCGA 9-3-90 do not apply to medical malpractice actions, which are instead governed by OCGA 9-3-73(b). The criteria for mental incompetence under OCGA 9-3-73(b) focus on the individual's ability to manage ordinary affairs of life.

Mental incapacity that tolls the statute of limitations is defined as an unsound mind that prevents a plaintiff from managing personal affairs, pursuing legal claims, or conducting daily life activities. This was established in various cases, including Lawson v. Glover and others. A claim of incompetency may be countered by the plaintiff's own testimony, indicating a lack of factual dispute regarding competency. Although the plaintiff in this case was mentally ill, her testimony indicated she was capable of managing daily life, making decisions, and voluntarily seeking and exiting treatment. Consequently, she was not legally incompetent under OCGA 9-3-73(b) to toll the statute of limitations.

In determining the timing of injuries related to misdiagnosis, each defendant's actions must be analyzed to see if they contributed to the injury or aggravated a pre-existing condition. The statute of limitations begins when the injury occurs and manifests damages. If damages arise from a misdiagnosis at a later time, the statute starts running upon discovery of those damages. Subsequent tortious acts that exacerbate an existing injury do not extend the statute of limitations for other tortfeasors unless they create a new indivisible injury. In this instance, the plaintiff's damages arose concurrently with the alleged misdiagnosis by Dr. Ulrici, and any subsequent damages were merely aggravations of a pre-existing injury, affecting the statute of limitations regarding Dr. Ulrici alone. Additionally, joint treatment by healthcare providers does not create a joint venture, meaning one provider's wrongful conduct cannot be imputed to another without a partnership.

A joint venture between health care providers requires joint control and the sharing of profits and losses; without these elements, it cannot legally exist. Charter and Parkwood were only obligated to supervise their employees and agents, not independent contractors like psychiatrists and psychologists who had staff privileges. The distinction between an employer-employee relationship and an independent contractor relationship hinges on whether the employer retains the right to control the specifics of how work is executed, rather than just the final outcomes as per the contract. Hospitals that do not dictate medical techniques but instead monitor the quality of care maintain an independent contractor relationship with the physicians. Consequently, the actions of Dr. Ulrici, even if conducted in conjunction with Charter and Parkwood, do not attribute liability to them for her conduct after October 12, 1992, and thus do not toll the statute of limitations against Charter and Parkwood. The judgment was reversed, with McMurray, P.J. concurring and Blackburn, J. concurring in judgment only.