October 23, 2001

JUSTICE COOK delivered the opinion of the court:

In October 1994, plaintiffs, David and Janet Warren,filed a two-count complaint against defendant, Stanley A. Burris,M.D. Plaintiffs' complaint alleges that on May 20, 1991, defendant performed surgery on David, consisting of a cholecystectomy(surgical excision of the gallbladder), operative cholangiography(X ray of the bile ducts), and an appendectomy; that thecholecystectomy was unnecessary; and that during the surgery,defendant severed the right hepatic duct and allowed a surgicalclip to remain on the duct, thereby obstructing it and preventingthe drainage of bile. In February 1998, defendant filed a motionfor summary judgment. In June 2000, the trial court granteddefendant's motion. Plaintiffs appeal, arguing that (1) whenDavid knew or should have known he was wrongfully injured is agenuine issue of material fact; (2) defendant's concealment ofDavid's injury delayed discovery of the injury and should tollthe statute of limitations; and (3) the trial court's finding asto fraudulent concealment precluded amendment of plaintiffs'complaint within the statute of limitations. We reverse andremand.

In May 1991, David went to Memorial Medical Center withthe following symptoms: vomiting, abdominal pain, and dehydration, and he had lost about 25 pounds in the past three to fourweeks. He also had difficulty eating greasy or fatty foods andsuffered abdominal pain that worsened after eating. Before May1991, David had been to the emergency room three times. Also atthat time, David had been disabled since a fall in November 1989in which he injured his middle and lower back and his heel. According to defendant, the back injuries themselves producedgas, bloating, and indigestion.

Dr. Raymond Pearson, David's original doctor, admittedDavid to the hospital. Pearson suggested that David see apsychiatrist for depression. Pearson informed David that depression could cause most or all of his symptoms. In his deposition,David stated that he now believed many of the symptoms that hewas suffering in May 1991 were caused by depression. However, atthe time, David believed that his illness was physical and thatwas part of the reason he asked to see another physician.

David asked Dr. Alfred Harney, an internist, to examinehim. Based upon an ultrasound of David's abdomen, Harney diagnosed David with gallstones and asked defendant to examine Davidbecause he believed David had a surgical problem. According toDavid, the woman who had performed the ultrasound on him told himthat she did not see any gallstones. Before the May 20, 1991,surgery, Jimmy Warren, David's brother--who is not a physician--was the only person that told David that he should not have thesurgery. Defendant told David that he would feel much betterafter the surgery, and David believed that he would have a fast,speedy recovery. David chose to go through with the surgery, anddefendant performed the surgery on May 20, 1991.

After the surgery, David's symptoms did not improve. One of the doctors at the hospital told David that he did not seeanything in David's report that would suggest the removal of thegallbladder.

In fall 1991, David had the same complaints that he hadprior to surgery. David went to Dr. Mark Harrison, agastroenterologist, who performed a liver biopsy on David. Dr.William Drake, the pathologist who reviewed the biopsy, foundthat David was suffering chronic active hepatitis. Harrison hadanother pathologist, Dr. Jordan Mann, review the biopsy. Mannfound that David had a mechanical large-duct obstruction. Drakethen issued a memorandum maintaining his position that Davidsuffered from hepatitis, not a duct obstruction. Harrisoninformed David of the two opinions and suggested that he undergoan endoscopic retrograde cholangiopancreatography (ERCP).

In November 1991, Harrison performed the ERCP on David. Harrison noticed the right side of the liver was not functioningnormally, but he was unsure of the condition's causation. Harrison told David that he suspected that David had a blockageof the biliary system. In his deposition, Harrison stated thathe believed he told David that defendant's surgery could havecaused the blockage. However, in his deposition David claimedthat Harrison did not make that statement. Harrison also suspected that David was suffering from depression because many ofthe symptoms that he was experiencing were consistent withdepression. Harrison referred David to a psychiatrist.

In late 1991, Harrison recommended that David go backto defendant. Defendant told David that he had an extra accessory duct that defendant had removed. Defendant suggested thatDavid needed exploratory surgery because a chance existed that hehad cancer. David refused to undergo surgery again.

In July 1992, David saw Dr. Phillip Johnson becauseDavid was having problems with elevated liver enzymes. At thattime, David did not feel his surgery was successful and suspectedthat defendant's surgery could have caused his liver problems. In his notes, Johnson remarked that David told him that defendanthad wanted to reopen his abdomen to look for surgical problems. In his deposition, David denied saying that. Johnson alsodiscussed with David the fact that his liver enzymes had becomeelevated after defendant's surgery. Johnson found no cleardiagnosis and suggested that cancer or an anatomic variant couldbe the cause of the elevated enzymes.

In September 1992, Harrison again examined David anddiagnosed him with irritable bowel syndrome. That same month,David also went to see Dr. Barbara Mulch, who referred him to Dr.Aliperti at Barnes Hospital in St. Louis. At that time, Davidwas still suffering the same symptoms that he had experiencedbefore the surgery. On October 21, 1992, David received acholangiogram at Barnes Hospital. The findings of thecholangiogram showed a "[c]omplete obstruction of the righthepatic lobe biliary system at the right level of the righthepatic duct, with adjacent surgical clips." Aliperti told Davidthat he needed to have surgery to remove the obstruction. Because of anxiety over the surgery, David chose not to undergothe surgery. In May 1993, David developed a bacterial infectionin the liver and underwent a hepaticojejunostomy, which consistedof the creation of a permanent bypass around the right hepaticduct so that bile would be properly drained.

On October 14, 1994, almost two years after the October21, 1991, cholangiogram, plaintiffs filed their complaint againstdefendant. In December 1998, defendant filed his motion forsummary judgment, alleging that plaintiffs' cause of action istime-barred. In February 1999, the trial court denied defendant's motion, finding a genuine issue about when David knew orreasonably should have known that his injury was wrongfullycaused. In April 2000, defendant filed a motion to reconsiderthe motion for summary judgment, relying on this court's decisionin Wilson v. Devonshire Realty of Danville, 307 Ill. App. 3d 801,718 N.E.2d 700 (1999). In June 2000, the trial court granteddefendant's motion, finding that David should have known hisinjury may have been wrongfully caused no later than July 1992(when David saw Dr. Johnson) and that plaintiffs failed to pleada prima facie case of fraudulent concealment. Plaintiffs filed amotion to reconsider, and in September 2000 the trial courtdenied plaintiffs' motion. This appeal followed.

Summary judgment is appropriate when the pleadings,depositions, admissions, and affidavits demonstrate no genuineissue of material fact exists and the movant is entitled tojudgment as a matter of law. 735 ILCS 5/2-1005(c) (West 1998);Rotzoll v. Overhead Door Corp., 289 Ill. App. 3d 410, 413, 681N.E.2d 156, 158 (1997). In ruling on a motion for summaryjudgment, the trial court must view all evidence in the lightmost favorable to the nonmovant. Malone v. American CyanamidCo., 271 Ill. App. 3d 843, 845, 649 N.E.2d 493, 495 (1995). Wereview grants of summary judgment de novo. Malone, 271 Ill. App.3d at 845, 649 N.E.2d at 495.

Plaintiffs argue that a genuine issue of material factexists about when David knew or reasonably should have known thathis injury was wrongfully caused. Specifically, plaintiffsassert that David knew the injury was wrongfully caused onOctober 21, 1992, when the cholangiogram showed the surgicalclips had completely obstructed the right hepatic duct. Defendant argues that David knew or should have known as a matter oflaw that the injury was wrongfully caused in July 1992 when Davidsuspected that the surgery may have caused his continued symptoms.

The applicable statute of limitations is found insection 13-212(a) of the Code of Civil Procedure (735 ILCS 5/13-212(a) (West 1994)), which requires an action for medical malpractice to be brought within two years from the date when theplaintiff knew, or reasonably should have known, of both thephysical problem and that it was wrongfully caused. Pruitt v.Schultz, 235 Ill. App. 3d 934, 936, 601 N.E.2d 1372, 1374 (1992). A person knows, or reasonably should know, an injury was wrongfully caused when he possesses "sufficient information concerninghis injury and its cause to put a reasonable person on inquiry todetermine whether actionable conduct is involved." Knox Collegev. Celotex Corp., 88 Ill. 2d 407, 416, 430 N.E.2d 976, 980-81(1981). Whether a person possesses sufficient information isusually a question of fact. Knox College, 88 Ill. 2d at 416, 430N.E.2d at 981. If only one conclusion can be drawn from theundisputed facts, then the question becomes one of law. Wilson,307 Ill. App. 3d at 805, 718 N.E.2d at 704. Close questions onthis issue should not be decided as a matter of law, but are bestleft for juries. Pruitt, 235 Ill. App. 3d at 936-37, 601 N.E.2dat 1375.

Plaintiffs begin by arguing that Wilson, 307 Ill. App.3d 801, 718 N.E.2d 700, is distinguishable. We agree. There,the plaintiff began experiencing respiratory problems in January1995. The plaintiff also knew then that several other coworkerswere suffering similar symptoms. Wilson, 307 Ill. App. 3d at803, 718 N.E.2d at 702. In August 1995, she questioned one ofthe defendants and a physician as to whether her ailments wererelated to the condition of the building in which she worked. Wilson, 307 Ill. App. 3d at 803, 718 N.E.2d at 703. In April1997, the plaintiff experienced a loss of consciousness, and apulmonary specialist diagnosed her with a pulmonary illness,which the specialist suggested could have been caused by irritants in the workplace. Wilson, 307 Ill. App. 3d at 803-04, 718N.E.2d at 703.

In February 1998, the plaintiff filed a complaintagainst the defendants. Wilson, 307 Ill. App. 3d at 804, 718N.E.2d at 703. The trial court granted the defendants' motionfor summary judgment, finding the cause of action was time-barred. Wilson, 307 Ill. App. 3d at 802, 718 N.E.2d at 702. Onappeal, the plaintiff argued that until her diagnosis in April1997 she was unaware of both her injury and its causal connectionto the defendants' actions. Wilson, 307 Ill. App. 3d at 805, 718N.E.2d at 704. This court affirmed the trial court's judgment. Wilson, 307 Ill. App. 3d at 808, 718 N.E.2d at 706.

As to the knowledge of the injury, this court heldthat, while the plaintiff did not know the full extent of herinjuries until April 1997, the plaintiff knew she had sufferedsome injury in January 1995. Wilson, 307 Ill. App. 3d at 806,718 N.E.2d at 705. The court further found that the plaintiffhad sufficient knowledge that her injury was wrongfully caused nolater than August 1995. Wilson, 307 Ill. App. 3d at 807, 718N.E.2d at 705. In support of the latter conclusion, the courtcited the plaintiff's knowledge of coworkers with similar problems, the plaintiff's lengthy discussion with the one of thedefendants in which she questioned whether the condition of herworkplace caused her illness, and the plaintiff's discussion withher physician regarding the possible connection between herworkplace and her illness. Wilson, 307 Ill. App. 3d at 806-07,718 N.E.2d at 705.

First, in deciding whether the discovery rule has beentriggered, courts must look to the specific type of injury atissue. Bradtke v. Reotutar, 214 Ill. App. 3d 611, 615, 574N.E.2d 110, 113 (1991). If an injury is traumatic, that is,immediate and caused by external force or violence, the plaintiffknows or should know of his right to sue when injured. However,if an injury is an aggravation of a physical problem that maydevelop naturally, absent negligent causes, a plaintiff is notexpected to immediately know of either its existence or potentialwrongful cause. Saunders v. Klungboonkrong, 150 Ill. App. 3d 56,60, 501 N.E.2d 882, 885 (1986).

In Wilson, the plaintiff suffered an injury that wastraumatic in nature. There, the irritants in the building causedthe plaintiff's injury and the injury was immediate. Wilson, 307Ill. App. 3d at 803, 718 N.E.2d at 702. Further, the plaintifffailed to present any evidence that her ailments could have beenthe result of natural causes.

Here, the symptoms that David was experiencing couldhave been the result of natural causes absent a negligent cause. Until the cholangiogram, none of the doctors that examined Davidcould determine the cause of his symptoms. The doctors toldDavid that he could have depression, hepatitis, irritable bowelsyndrome, cancer, or a blockage of the hepatic duct caused bystones or tumors. Further, the facts are disputed whether any ofDavid's doctors told him that defendant's surgery could havecaused his symptoms.

David's injury is not as readily apparent as thoseresulting from traumatic events. See Golla v. General MotorsCorp., 167 Ill. 2d 353, 363, 657 N.E.2d 894, 899 (1995) (plaintiff immediately aware of some injury after an automobile accident); Hutson v. Hartke, 292 Ill. App. 3d 411, 414, 686 N.E.2d734, 737 (1997) (plaintiff almost blacked out when she noticed astrong odor). The more obvious the injury, the more easily aplaintiff can determine its cause. Saunders, 150 Ill. App. 3d at60, 501 N.E.2d at 885. David's injury was not as obvious as theone sustained in Wilson, and thus its cause could not have beenas easily determined. It is difficult to fault a patient who isbeing treated by a skilled medical professional for not recognizing the occurrence of any injury, when the professional has nottold him of the injury. In hindsight, almost everything isforeseeable, but that is not the test we should employ. It doesnot appear that David ignored the evidence presented to him;rather, David consistently sought medical assistance to learn thecause of the problems that he was experiencing.

Second, we do not find that only one conclusion can bedrawn from the facts of this case about when David knew he hadsuffered a wrongfully caused injury. Wilson did not create a perse rule that any suspicion by the plaintiff is, as a matter oflaw, reasonable knowledge under the discovery rule. Courts applythe discovery rule on a case-by-case basis. Hermitage Corp. v.Contractors Adjustment Co., 166 Ill. 2d 72, 78, 651 N.E.2d 1132,1135 (1995).

Unlike Wilson, the facts here are disputed aboutwhether David had conversations with defendant or any otherdoctor in which he questioned whether defendant's surgery causedhis symptoms. Further, David did not develop new symptoms, nordid his symptoms worsen after the surgery. In addition, nosupporting evidence such as coworkers with the same symptoms hasbeen asserted in this case.

Here, several doctors told David that depression oranother illness could have caused his symptoms. Even when somedoctors agreed that David had a blockage, the doctors gave Davidseveral possible causes or etiologies for the blockage. In thiscase, different inferences could reasonably be drawn from thesefacts about when a reasonable person would have known Davidsuffered a wrongfully caused injury.

In cases involving the aggravation of a problem thatmay arise absent negligent causes, the time when the plaintiffknew or reasonably should have known the injury was wrongfullycaused generally presents a question of fact rather than law. Bradtke, 214 Ill. App. 3d at 618, 574 N.E.2d at 115. Here, atwhat point David knew or should have known of the injury and itspossible cause is not certain. David was aware of a physicalproblem, but when he became aware of the true nature of hisailment is disputed. Thus, we find a genuine issue of materialfact exists.

In light of our holding, we need not address plaintiffs' arguments that (1) defendant's concealment of David'sinjury delayed discovery of the injury and should toll thestatute of limitations and (2) the trial court's finding as tofraudulent concealment precluded amendment of plaintiffs' complaint within the statute of limitations.

Accordingly, we reverse the trial court's judgment andremand for further proceedings consistent with this opinion.

Reversed and remanded.

McCULLOUGH and MYERSCOUGH, JJ., concur.