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IN THE COURT OF APPEALS OF IOWA No. 1-761 / 11-0142 Filed December 21, 2011 EDWARD J. HANSSEN and CONNIE S. HANSSEN, Plaintiffs-Appellants, vs. GENESIS HEALTH SYSTEM, a Corporation, Defendant-Appellee. ________________________________________________________________ Appeal from the Iowa District Court for Scott County, Paul Macek, Judge.

Edward and Connie Hanssen appeal the district court's grant of summary judgment based on the couple's failure to file the medical malpractice claim within the two-year statute of limitations. REVERSED AND REMANDED.

William J. Bribriesco of William J. Bribriesco & Associates, Bettendorf, for appellants. Diane M. Reinsch and Joshua T. Mandelbaum of Lane & Waterman, L.L.P., Davenport, for appellee.

Considered by Sackett, C.J., and Vaitheswaran and Tabor, JJ.

2 TABOR, J. Edward and Connie Hanssen contend the district court was wrong in finding they waited too long to file their medical malpractice lawsuit against Genesis Health Systems (Genesis or the hospital). The Hanssens ask us to reverse the grant of summary judgment, urging that a genuine issue of material fact exists regarding both the date they knew about Edward's injury and its cause, as well as whether the hospital should be equitably estopped from raising a statute of limitations defense based on the doctrine of fraudulent concealment. Because the record contains evidence upon which reasonable minds might conclude Genesis affirmatively misrepresented the circumstances and cause of Edward's injury and that the Hanssens briefly relied on that misrepresentation to their detriment, we find summary judgment based on the two-year statute of limitations was inappropriate. I. Background Facts and Proceedings The facts viewed most favorably to the Hanssens reveal the following events significant to our consideration of this summary judgment appeal. See generally Christy v. Miulli, 692 N.W.2d 694, 698 (Iowa 2005) (viewing entire record in light most favorable to nonmoving party and indulging every legitimate inference the evidence will bear on behalf of nonmoving party). Edward Hanssen underwent knee surgery on September 25, 2007. On that same date, orthopedic surgeon Matthew Lindaman prescribed post-

3 operative medications for Hanssen. Specifically, he ordered Oxycontin1 and

Oxycodone2 to help manage Edward's pain. During morning rounds on September 27, 2007, Dr. Lindaman learned from Edward that he had not slept well and was experiencing pain. The surgeon ordered twenty milligrams of OxyContin orally three times a day, as well as Xanax. Genesis nurses administered the first dose of Oxycontin at 9:40 a.m. and the second dose at 2 p.m. Connie grew concerned that her husband acted very lethargic. After consulting with a family member, Connie asked a nurse not to give Edward any more pain medication. A nurse reported Edward's lethargy to Dr. Lindaman, who issued new orders at 3:15 p.m. The doctor discontinued the twenty milligrams of OxyContin and substituted a ten-milligram dose, along with one to two tablets of Oxycodone every four to six hours as needed. At 11:25 p.m. on September 27, 2007, a nurse assessed Edward as being "not oriented to time" and "lethargic." His oxygen saturation dropped to 55

percent on room air. The nurse placed Edward back on oxygen and encouraged him to take deep breaths, increasing his saturation level to 92 percent. The

nurse reported Edward's condition to the on-call doctor, who ordered the nurse to administer Narcan and discontinue the pain medications. When Connie returned to the hospital at 6:30 a.m. September 28, 2007, she learned from a nurse's aide that Edward fell twice in the bathroom during the night. About an hour later, Dr. Lindaman assessed Edward with narcotic

The doctor's faxed order prescribed Oxycontin in an amount of "10 mg orally every 8 hours x's 3 doses." 2 The order prescribed Oxycodone in an amount of "5 mg orally for pain scale 3-5 or 10 mg for pain scale of 6 or more every 3 hours p.r.n. `break-through' pain."
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4 aspiratory depression. Dr. Andrew Edwards, the family's physician, also stopped by the hospital room that morning and told the Hanssens he believed that Edward had a narcotic overdose. Genesis discharged Edward around 6 p.m. on September 28, 2007. But shortly after he arrived home, his heart began racing and he experienced severe sweating. Connie called Dr. Edwards, who recommended they return to the

hospital. Connie drove her husband to the emergency room (ER) at Genesis East. The ER doctor looked up Edward's records on the computer and told the Hanssens that Edward had been overmedicated. During the night of September 28, 2007, Edward became confused and agitated. On the morning of September 29, 2007, Edward commented to a nurse: "I used to be a contributing member of society and now because of that medicine I was double dosed on, I feel like a vegetable." Both the nurse and Dr . Edwards assured Edward he was "not a vegetable" and just needed some undisturbed sleep. On October 1, 2007, Dr. Edwards ordered an MRI and CT scan for Edward because the doctor was concerned about potential memory loss. In recording the "relevant clinical history," the MRI technician wrote that Edward stated: "2 oxycodone overdoses within 4 hrs, last OD on 9/27/07." That same day, Dr. Edwards completed his clinical summary of Edward's diagnoses, including tachycardia, a racing heart rate, and hypoxemia, a low oxygen level -- both due to the pain medication he received. Connie acknowledged that Dr. Edwards explained these conditions before discharging her husband.

5 Before Edward's discharge from Genesis East on October 1, 2007, the Hanssens met with patient advocate Lori Crane. The Hanssens told Crane they were unhappy with the nursing care Edward received at Genesis West. Crane's documentation of the conversation including the following note: Pt & wife upset that staff did not tune into pt's lethargy after receiving OxyContin & wanted to give him more

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