Medical Malpractice--Rule 9(j) certification lacking in original complaint--amended
complaint--Rule 15 prevents dismissal
The trial court erred in a medical malpractice action by dismissing plaintiff's original and
amended complaints based on an alleged failure to comply with the certification requirements of
N.C.G.S. § 1A-1, Rule 9(j), because: (1) a complaint may be amended under N.C.G.S. § 1A-1,
Rule 15 to prevent dismissal for failure to include Rule 9(j) certification; (2) Rule 9(j)
certification that the medical care has been reviewed by a medical expert is merely a pleading
requirement and has no effect on plaintiff's burden of proof under N.C.G.S. § 90-21.12; (3)
plaintiff's amended complaint with the inclusion of the Rule 9(j) certification must be deemed
under Rule 15(c) to have been filed at the time of the original complaint since plaintiff's original
complaint includes notice of transactions or occurrences sufficient to allege medical malpractice
under N.C.G.S. § 90-21.12; (4) plaintiff's amended complaint is not prevented from relating back
under Rule 15(c) since all parties and all claims were the same in both plaintiff's original and
amended complaints; (5) an amended complaint certifying that a medical review took place,
without more, satisfies the language of Rule 9(j); (6) a plaintiff could not unilaterally extend the
time for certification by amending later without the necessity of a showing of good cause when a
plaintiff is bound under N.C.G.S. § 1A-1, Rule 11(a) by a duty of good faith when filing a
complaint; and (7) the statute of limitations was extended pursuant to Rule 9(j) meaning plaintiff
filed her original complaint within the extended statute of limitations.
Judge BIGGS dissenting.
Jimmy F. Gaylor for plaintiff-appellant.
Harris, Shields, Creech & Ward, P.A., by C. David Creech and
W. Gregory Merritt, for defendant-appellee Corazon Ngo, M.D.
Smith, Anderson, Blount, Dorsett, Mitchell & Jernigan, LLP, by
John D. Madden and Deanna Davis Anderson, for defendant-
appellee Onslow County Hospital Authority.
McGEE, Judge.
Plaintiff appeals the dismissal of her medical malpracticesuit as to defendants Corazon Ngo, M.D. (Ngo) and Onslow
County
Hospital Authority (OCHA) pursuant to N.C. Gen. Stat. § 1A-1, Rules
12(b)(6) and 9(j). For the reasons stated below, we reverse the
trial court's dismissal.
Plaintiff alleges that defendants committed medical
malpractice on 8 June 1996. On 8 June 1999, plaintiff secured an
extension of 120 days to the three-year statute of limitations for
actions for medical malpractice pursuant to N.C. Gen. Stat. § 1A-1,
Rule 9(j). On 6 October 1999, the final day of the extension,
plaintiff filed a complaint which lacked the certification required
by Rule 9(j). On 12 October 1999, before defendants had filed
responsive pleadings, plaintiff amended her complaint as a matter
of course pursuant to N.C. Gen. Stat. § 1A-1, Rule 15(a) to include
the requisite Rule 9(j) certification.
Defendants Ngo and OCHA moved to dismiss plaintiff's complaint
in November 1999 pursuant to N.C. Gen. Stat. § 1A-1, Rules 12(b)(6)
and 9(j). On 17 November 1999, the trial court dismissed
plaintiff's original complaint as to defendants Ngo and OCHA
pursuant to Rule 9(j) for lack of certification and dismissed
plaintiff's amended complaint as to defendants Ngo and OCHA
pursuant to Rule 12(b)(6) insofar as it was barred by the statute
of limitations for actions for medical malpractice. Plaintiff
appeals the dismissals.
As a preliminary matter, we note that plaintiff has failed to
adhere to the N.C. Rules of Appellate Procedure in her brief to
this Court. The argument portion of plaintiff's brief does not
specify the pertinent assignments of error, as required by N.C.R.App. P. 28(b)(5). At the conclusion of plaintiff's brief,
plaintiff's counsel failed to identify himself and sign his name,
as required by N.C.R. App. P. 28(b)(7). "The Rules of Appellate
Procedure are mandatory and failure to follow the rules subjects an
appeal to dismissal." Wiseman v. Wiseman, 68 N.C. App. 252, 255,
314 S.E.2d 566, 567-68 (1984). However, in the interest of
justice, we suspend the requirements of N.C.R. App. P. 28(b)(5) and
(7) for plaintiff in the present case pursuant to N.C.R. App. 2.
The present case turns on the relationship between N.C. Gen.
Stat. § 1A-1, Rule 9(j) and N.C. Gen. Stat. § 1A-1, Rule 15.
"'Legislative intent controls the meaning of a statute.' To
determine legislative intent, a court must analyze the statute as
a whole, considering the chosen words themselves, the spirit of the
act, and the objectives the statute seeks to accomplish." Brown v.
Flowe, 349 N.C. 520, 522, 507 S.E.2d 894, 895 (1998) (citations
omitted). Rule 9(j) provides:
Any complaint alleging medical malpractice by
a health care provider . . . shall be
dismissed unless:
(1) The pleading specifically asserts
that the medical care has been reviewed by a
person who is reasonably expected to qualify
as an expert witness . . . and who is willing
to testify that the medical care did not
comply with the applicable standard of care;
(2) The pleading specifically asserts
that the medical care has been reviewed by a
person that the complainant will seek to have
qualified as an expert witness . . . and who
is willing to testify that the medical care
did not comply with the applicable standard of
care . . . ; or
(3) The pleading alleges factsestablishing negligence under the exi
sting
common-law doctrine of res ipsa loquitur.
N.C. Gen. Stat. § 1A-1, Rule 9(j) (1999) (emphasis added). Rule
15(a) provides:
A party may amend his pleading once as a
matter of course at any time before a
responsive pleading is served. . . .
Otherwise a party may amend his pleading only
by leave of court or by written consent of the
adverse party; and leave shall be freely given
when justice so requires.
N.C. Gen. Stat. § 1A-1, Rule 15(a) (1999). At issue is whether a
complaint may be amended under Rule 15 to prevent dismissal for
failure to include Rule 9(j) certification.
Rule 9 sets out a number of specialized pleading requirements,
including rules for averring fraud and for seeking special damages.
See, e.g., N.C. Gen. Stat. § 1A-1, Rule 9(b) and (g). Although
many of the subsections of Rule 9 include the word "shall" in their
directives to parties filing pleadings, only subsection (j)
includes the phrase "shall be dismissed," presumably a directive to
the trial court. Since failure to follow the requirements laid out
in any subsection of Rule 9 entitles an opposing party to
dismissal, see, e.g., N.C. Gen. Stat. § 1A-1, Rule 41(b), we must
determine whether the General Assembly's use of the specific phrase
"shall be dismissed" was intended to preclude amendment to a
pleading under Rule 15.
In Keith v. Northern Hosp. Dist. of Surry County, 129 N.C.
App. 402, 499 S.E.2d 200, disc. review denied, 348 N.C. 693, 511
S.E.2d 646 (1998), the judge writing the opinion for the panel
concluded that the inclusion of "shall be dismissed" in Rule 9(j)acted to prevent a plaintiff from subsequently amending a compla
int
under Rule 15 to add the requisite Rule 9(j) certification.
However, another judge on the panel disagreed with that reasoning
and concluded that the language of Rule 9(j), when read in pari
materia with Rule 15, allowed correction through amendment. That
second judge concurred in the result only, on the basis of the
trial court's discretion to deny an amendment under Rule 15.
Because the third judge on the Keith panel also concurred in the
result only, on the basis of discretion under Rule 15, the
precedential authority of Keith is limited to its holding that the
trial court did not abuse its discretion under Rule 15. See, e.g.,
State v. Bryant, 334 N.C. 333, 341, 432 S.E.2d 291, 296 (1993),
vacated on other grounds, 511 U.S. 1001, 128 L. Ed. 2d 42 (1994).
Although portions of the principal opinion in Keith were
subsequently quoted by and thus incorporated into Allen v. Carolina
Permanente Med. Grp., P.A., 139 N.C. App. 342, 533 S.E.2d 812
(2000), Allen did not address the application of Rule 15 to Rule
9(j) and therefore holds no precedential value applicable to the
case before us.
In Brisson v. Kathy A. Santoriello, M.D., P.A., 351 N.C. 589,
528 S.E.2d 568 (2000), our Supreme Court held that a complaint
lacking Rule 9(j) certification may be voluntarily dismissed
pursuant to N.C. Gen. Stat. § 1A-1, Rule 41(a)(1) and re-filed
within a year with the requisite Rule 9(j) certification, even if
the statute of limitations had already expired before the complaintwas dismissed. Brisson at 595, 528 S.E.2d at 571. However, the
Court explicitly declined to address whether amendment of a
complaint pursuant to Rule 15 would similarly allow an action to
proceed. Id. at 593, 528 S.E.2d at 570. Nonetheless, Brisson does
assist our analysis of the interaction between Rules 9(j) and 15.
Rule 41(a)(1) provides that
an action or any claim therein may be
dismissed by the plaintiff without order of
court . . . by filing a notice of dismissal at
any time before the plaintiff rests his
case. . . . Unless otherwise stated in the
notice of dismissal . . . , the dismissal is
without prejudice. . . . If an action
commenced within the time prescribed therefor,
or any claim therein, is dismissed without
prejudice under this subsection, a new action
based on the same claim may be commenced
within one year after such dismissal[.]
N.C. Gen. Stat. § 1A-1, Rule 41(a)(1) (1999). In Brisson, noting
that "[s]tatutes dealing with the same subject matter must be
construed in pari materia and harmonized, if possible, to give
effect to each[,]" Bd. of Adjmt. of the Town of Swansboro v. Town
of Swansboro, 334 N.C. 421, 427, 432 S.E.2d 310, 313 (1993)
(citation omitted), the Supreme Court stated:
Although Rule 9(j) clearly requires a
complainant of a medical malpractice action to
attach to the complaint specific verifications
regarding an expert witness, the rule does not
expressly preclude such complainant's right to
utilize a Rule 41(a)(1) voluntary dismissal.
Had the legislature intended to prohibit
plaintiffs in medical malpractice actions from
taking voluntary dismissals where their
complaint did not include a Rule 9(j)
certification, then it could have made such
intention explicit. In this case, the plain
language of Rule 9(j) does not give rise to an
interpretation depriving plaintiffs of theone-year extension pursuant to their Rule
41(a)(1) voluntary dismissal merely because
they failed to attach a Rule 9(j)
certification to the original complaint.
Brisson at 595, 528 S.E.2d at 571. The question in the case before
this Court is whether the plain language of Rule 9(j) gives rise to
an interpretation depriving plaintiff of the Rule 15 right to amend
a complaint to correct a failure to include a Rule 9(j)
certification.
One possible interpretation of Rule 9(j)'s "shall be
dismissed" language is that a complaint lacking the necessary Rule
9(j) certification is to be deemed dismissed and therefore a
nullity immediately upon its filing with the trial court. Under
that interpretation, an attempt to amend such a complaint pursuant
to Rule 15 would in fact constitute the filing of a new complaint,
possibly after the statute of limitations had expired. However, we
find that such an interpretation is not possible under Brisson. If
the complaint in Brisson had been deemed dismissed automatically
upon its initial filing, voluntary dismissal under Rule 41(a)(1)
would no longer have been available. See N.C. Gen. Stat. § 1A-1,
Rule 41(a)(1). It therefore follows that a complaint "shall be
dismissed" under Rule 9(j) only through action by a trial court.
A second interpretation of "shall be dismissed" might be that
a complaint filed without necessary Rule 9(j) certification is to
be dismissed upon motion by a defendant, but the complaint cannot
be amended by a plaintiff before that motion to dismiss is ruled
upon. In other words, "shall be dismissed" would be read to
exclude any action upon the complaint except dismissal. Thatinterpretation could be reconciled with Brisson, insofar as a
voluntary dismissal under Rule 41(a)(1) is a form of dismissal.
However, such an interpretation of Rule 9(j) would require a
legislative intent to permit a voluntary dismissal with a one-year
extension to re-file while categorically prohibiting the
achievement of any similar effect through immediate amendment.
To correct a lack of Rule 9(j) certification through either a
Rule 41(a)(1) voluntary dismissal or a Rule 15 amendment, a
plaintiff would have to make an appropriate filing sometime before
the trial court involuntarily dismissed the action. A Rule
41(a)(1) voluntary dismissal may be taken without leave of the
court and a plaintiff is allowed up to a full year to re-file the
complaint. See N.C. Gen. Stat. § 1A-1, Rule 41(a)(1). A Rule 15
amendment may only be made as a matter of course once, before an
opponent files a responsive pleading, or leave of the court is
required to amend, and the amendment would provide a plaintiff no
additional time. See N.C. Gen. Stat. § 1A-1, Rule 15(a).
Defendants argue that a Rule 41(a)(1) voluntary dismissal is
distinguishable from a Rule 15 amendment by virtue of the duty of
good faith imposed upon a Rule 41(a)(1) dismissal under Estrada v.
Burnham, 316 N.C. 318, 341 S.E.2d 538 (1986). In Estrada, our
Supreme Court held that a complaint filed solely with the intention
of dismissing it under Rule 41(a)(1) so as to gain a one-year
extension to the statute of limitations violated N.C. Gen. Stat. §
1A-1, Rule 11(a). See Estrada at 323, 341 S.E.2d at 542. However,
the same Rule 11(a), and thus the same duty of good faith, likewiseapply to a complaint filed solely for the purpose of amending it
later under Rule 15 in a similar effort to extend the relevant
statute of limitations. See N.C. Gen. Stat. § 1A-1, Rule 11(a)
(1999).
The language of Rule 9(j) does not indicate why the General
Assembly would have intended to permit a Rule 41(a)(1) voluntary
dismissal to the exclusion of a Rule 15 amendment. "'[T]he absence
of any express intent and the strained interpretation necessary to
reach the result urged upon us by [defendants] indicate that such
was not [the legislature's] intent.'" Brisson at 595, 528 S.E.2d
at 571 (citation omitted). We conclude that Rule 9(j)'s "shall be
dismissed" language does not prevent amendment of a complaint
lacking requisite Rule 9(j) certification.
A third interpretation of "shall be dismissed" is simply that
a complaint lacking Rule 9(j) certification is to be dismissed by
a trial court upon motion by a defendant. As such, Rule 9(j) would
be treated no differently than any other subsection of Rule 9. We
note that, insofar as subsection (j) is the only subsection of Rule
9 to include the directive "shall be dismissed," "'[t]he
presumption is that no part of a statute is mere surplusage, but
each provision adds something which would not otherwise be included
in its terms.'" City of Concord v. Duke Power Co., 346 N.C. 211,
217, 485 S.E.2d 278, 282 (1997) (citation omitted). However, we
also note that subsection (j) is the only subsection of Rule 9 to
include multiple alternative mandates. We conclude that the use by
the General Assembly of the phrase "shall be dismissed" in Rule9(j) is adequately explained simply as a choice of grammatical
construction.
Defendants assert that, even if Rule 9(j) permitted plaintiff
to amend her complaint under Rule 15, the amended complaint cannot
be deemed to have been filed before the statute of limitations
expired. Relation back of amendments is governed by subsection (c)
of Rule 15:
A claim asserted in an amended pleading is
deemed to have been interposed at the time the
claim in the original pleading was interposed,
unless the original pleading does not give
notice of the transactions, occurrences, or
series of transactions or occurrences, to be
proved pursuant to the amended pleading.
N.C. Gen. Stat. § 1A-1, Rule 15(c) (1999). In the present case,
each claim asserted in the amended complaint was first asserted in
the original complaint. See Hyder v. Dergance, 76 N.C. App. 317,
332 S.E.2d 713 (1985) ("[A]n amended complaint has the effect of
superseding the original complaint."). The principal difference
between the original complaint and the amended complaint is the
addition of certification pursuant to Rule 9(j) that plaintiff's
medical care had been reviewed by a medical expert.
Defendants argue that the medical review required under Rule
9(j) is a transaction or occurrence to be proved pursuant to a
claim of medical malpractice and therefore, because plaintiff's
original complaint lacked notice of the review, Rule 15(c) prevents
the relation back of plaintiff's amended complaint. We disagree
with defendants' characterization of the Rule 9(j) medical review.
A medical malpractice action, as defined in N.C. Gen. Stat. § 90-
21.11 (1999), seeks damages for personal injury or death arisingout of professional medical care. The Rule 9(j) certification that
the medical care has been reviewed by a medical expert is merely a
pleading requirement imposed under the N.C. Rules of Civil
Procedure and has no effect on the plaintiff's burden of proof
under N.C. Gen. Stat. § 90-21.12 (1999). We therefore conclude
that, insofar as plaintiff's original complaint includes notice of
transactions or occurrences sufficient to allege medical
malpractice under § 90-21.12, plaintiff's amended complaint, Rule
9(j) certification included, must be deemed under Rule 15(c) to
have been filed at the time of the original complaint.
Defendants also assert that Crossman v. Moore, 341 N.C. 185,
459 S.E.2d 715 (1995) prevents plaintiff's amended complaint from
relating back under Rule 15(c). In Crossman, our Supreme Court
considered an effort to amend a complaint to include an additional
defendant after the statute of limitations had expired.
When the amendment seeks to add a
party-defendant or substitute a
party-defendant to the suit, the required
notice cannot occur. As a matter of course,
the original claim cannot give notice of the
transactions or occurrences to be proved in
the amended pleading to a defendant who is not
aware of his status as such when the original
claim is filed.
Crossman at 187, 459 S.E.2d at 717. In the present case, plaintiff
did not seek to add new defendants to her action when she amended
her complaint. Because all parties and all claims were the same in
both plaintiff's original and amended complaints, the defendants
named in the amended complaint had no less notice of the
transactions or occurrences to be proved than they received fromthe original complaint. Crossman does not prevent relation back in
the present case.
Defendants assert that, even if an amended complaint may
relate back to the filing of an original complaint under Rule 9(j),
the amended complaint in the present case nonetheless failed to
meet the requirements of Rule 9(j) because it did not assert that
the requisite medical review actually took place prior to the
filing of the original complaint. Defendants point first to the
language of Rule 9(j) that "[a]ny complaint alleging medical
malpractice . . . shall be dismissed unless . . . [t]he pleading
specifically asserts that the medical care has been reviewed[,]"
N.C. Gen. Stat. § 1A-1, Rule 9(j), as an indication that such
review must take place before the original complaint is filed.
However, that language does not mention an original complaint or
when the review must occur. Rule 9(j) requires only that
certification of the review be included in the complaint. We
conclude that an amended complaint certifying that a medical review
took place, without more, satisfies that language of Rule 9(j).
Defendants point next to the 120-day extension to the statute
of limitations permitted under Rule 9(j):
Upon motion by the complainant prior to the
expiration of the applicable statute of
limitations, a resident judge . . . may allow
a motion to extend the statute of limitations
for a period not to exceed 120 days to file a
complaint in a medical malpractice action in
order to comply with this Rule, upon a
determination that good cause exists for the
granting of the motion and that the ends of
justice would be served by an extension.
N.C. Gen. Stat. § 1A-1, Rule 9(j). Defendants argue that allowingsubsequent certification and relation back would render the 120-day
extension meaningless, since a plaintiff could unilaterally extend
the time for certification by amending later without the necessity
of any showing of good cause. However, as noted above, a plaintiff
is bound by a duty of good faith when filing a complaint. See N.C.
Gen. Stat. § 1A-1, Rule 11(a). In addition, once a plaintiff has
filed a complaint lacking necessary Rule 9(j) certification, a
defendant is entitled to move for dismissal, and the plaintiff's
action will be dismissed if the plaintiff does not amend the
complaint to include certification before the trial court rules on
the motion. If the plaintiff has already amended the complaint
once, or the defendant has already served a responsive pleading on
the plaintiff, the plaintiff may amend the complaint only with
leave of the trial court. See N.C. Gen. Stat. § 1A-1, Rule 15(a).
Because a plaintiff is bound by a duty of good faith, and because
a plaintiff's ability to accomplish review and certification after
the expiration of the statute of limitations can be effectively
limited through action of the defendant, we conclude that relation
back pursuant to Rule 15(c) of an amended complaint including only
the barest Rule 9(j) certification of review does not render
meaningless the Rule 9(j) 120-day extension of the statute of
limitations.
Finally, defendants assert that, because plaintiff failed to
file a Rule 9(j)-certified complaint within the 120-day extension
permitted under Rule 9(j), the purpose of the extension was
defeated and the extension should not apply. With no extension,
defendants contend that even plaintiff's original, non-certifiedcomplaint was filed after the expiration of the statute of
limitations and therefore that relation back under Rule 15(c) would
not help plaintiff. Defendants cite Osborne v. Walton, 110 N.C.
App. 850, 431 S.E.2d 496 (1993), in which a plaintiff requested and
received a 20-day extension to file a complaint, then filed the
complaint more than twenty days later. Our Court held that the
extension could not apply to the complaint, and that by the time
the complaint was filed the relevant statute of limitations had
expired. See id. at 854, 431 S.E.2d at 449.
However, Rule 9(j) does not just grant an extension of time to
file a Rule 9(j)-certified complaint, cf. N.C. Gen. Stat. § 1A-1,
Rule 3(a) (1999), it actually extends the underlying statute of
limitations. We conclude that the language of Rule 9(j) is not
intended to retroactively condition the extension of the statute of
limitations upon compliance with the requirement of certification,
but instead is intended to guide the resident superior court judge
in deciding whether good cause exists to grant the extension. In
the present case, the statute of limitations was extended pursuant
to Rule 9(j), and plaintiff filed her original complaint within
that extended statute of limitations. Under Rule 15, plaintiff was
permitted to amend her complaint to bring it into compliance with
Rule 9(j). We find no violation of Rule 9(j) or the statute of
limitations in the present case.
In summary, we hold that plaintiff was entitled to amend her
initial complaint to include the necessary Rule 9(j) certification,
and to have the amended complaint relate back to the filing of theinitial complaint. In doing so, we reject defendants' contention
that the purpose of Rule 9(j) is to act as a gatekeeper at the time
of filing a medical malpractice action. After consideration of the
language of Rule 9(j), and in light of Brisson, we conclude that
the intent of the General Assembly was to prevent the filing of
frivolous medical malpractice suits by providing defendants with a
means for quick dismissal unless appropriate Rule 9(j) review is
performed and certified. In the present case, appropriate Rule
9(j) review was performed and certified before the action was
dismissed. It follows that the dismissal of plaintiff's action was
in error.
We reverse the trial court's dismissals of plaintiff's
original and amended complaints.
Reversed.
Judge WYNN concurs.
Judge BIGGS dissents.
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