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RSMo. §516.105 provides that patients have two years to file medical malpractice actions against health-care and mental-health providers subject to limited, judicially-created exceptions.
In Templeton v. Orth¹, a case just handed down by Missouri’s Supreme Court, Mr. Templeton was involved in a golf cart accident on September 16, 2012, at which time he was ejected into a barbed wire fence and tree, injuring his right leg. Dr. Orth began treating him on September 18, 2012, and subsequently operated on his leg. Dr. Orth released Mr. Templeton from his care on December 6, 2012, via a clinic note stating “I am releasing [Templeton] from my care.”

More than three years later, Mr. Templeton sought care from Dr. Orth a second time and Dr. Orth performed several procedures on Mr. Templeton over the course of three months. Dr. Orth continued treating Mr. Templeton until his last appointment on August 16, 2016, at which time Dr. Orth prescribed antibiotics and advised Mr. Templeton to return for follow up care. Instead of returning to Dr. Orth, Mr. Templeton sought a second opinion from Dr. Tilley on September 7, 2016. At that time, Dr. Tilley advised Mr. Templeton to stop taking the medication prescribed by Dr. Orth to see if the condition worsened (which would be indicative of an infection). Mr. Templeton stopped taking the medication and returned to Dr. Tilley for follow up care on October 10, 2016. The following day, Dr. Tilley performed surgery on Mr. Templeton’s leg, finding two foreign bodies that may have entered his leg during the 2012 golf cart accident.

Two years later, on October 9, 2018, Mr. Templeton filed a medical malpractice action against Dr. Orth, who filed a Motion for Summary Judgment predicated on RSMo. 516.105, arguing that Plaintiff’s claims were barred by the two-year statute of limitations because Mr. Templeton terminated the physician/patient relationship when he sought treatment from Dr. Tilley without following up with Dr. Orth. In response, Plaintiff sought to have the statute of limitations tolled under the “continuous-course-of-treatment” or “continuing care” doctrine.

The circuit court granted Defendant’s Motion for Summary Judgment. Plaintiff appealed arguing the circuit court erred because a genuine issue of material fact existed over whether the continuing care doctrine applied and when the tolling ended.

The continuing care doctrine is an exception to the two-year statute of limitations which tolls the statute of limitations in limited circumstances where a patient has experienced an act of medical malpractice by his physician and continues to receive care from that same physician. The Missouri Supreme Court has explained that care continues (and thereby the statute is tolled) unless the physician/patient relationship is ended by mutual consent, physician’s withdrawal after reasonable notice, dismissal of the physician by the patient, or the necessity of the treatment that gave rise to the relationship ceases.²

With respect to Dr. Orth’s care of Mr. Templeton, Mr. Templeton sought a second opinion from Dr. Tilley, received an alternative treatment plan, and consciously chose to follow Dr. Tilley’s plan without further notice to Dr. Orth. The Supreme Court of Missouri found that based on the three aforementioned actions, the only reasonable inference was that Mr. Templeton intended to terminate his physician/patient relationship with Dr. Orth. The Court noted that any one of these actions standing alone may not have been sufficient to terminate the continuing care relationship, but the combination of same effectively ended the relationship and started the clock for filing a lawsuit against Dr. Orth, starting on the date of the earliest of the three actions.

In making its decision, the Supreme Court rejected Mr. Templeton’s argument that his physician/patient relationship ended when the necessity of care ceased, i.e., when Dr. Tilley operated on Mr. Templeton to remove the foreign bodies. The Court found that the “necessity” circumstance under the continuing care doctrine described the outer bounds of the relationship, therefore the determination of when the necessity ceased was irrelevant if the relationship was terminated earlier by one of the other methods. Accordingly, Mr. Templeton terminated the continuing care relationship before the necessity ended when he saw Dr. Tilley, received an alternative treatment plan, and heeded Dr. Tilley’s advice without consulting Dr. Orth.

With its decision, the Missouri Supreme Court effectively foreclosed Mr. Templeton’s attempt to create a loophole to RSMo. 516.105, which would have allowed Plaintiffs to expose health care providers to indefinite medical malpractice lawsuits based solely on the subjective views of patients as to when their relationship with a physician ended.

¹ Templeton v. Orth, 2024 Mo. LEXIS 5 * (Jan. 30, 2024).

² Weiss v. Rojanasathit, 975 S.W.2d 113 (Mo. Banc 1998).

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