Indiana’s Medical Malpractice Statute of Limitations

Indiana’s two-year, occurrence-based statute of limitations for medical malpractice claims is contained at IC § 34-18-7-1.  In pertinent part, this statute states that “[a] claim, whether in contract or tort, may not be brought against a health care provider based upon professional services or health care that was provided or that should have been provided unless the claim is filed within two (2) years after the date of the alleged act, omission, or neglect….”  This occurrence-based statute of limitations has been upheld as constitutional on its face under the Indiana Constitution, Article I, Sections 12 and 23, but has also been held to be unconstitutional as applied in certain circumstances.  Garneau v. Bush, M.D., 838 N.E.2d 1134, 1141 (Ind. Ct. App. 2005), Van Dusen v. Stotts, 712 N.E.2d 491, 493 (Ind. 1999); Martin v. Richey, 711 N.E.2d 1273, 1284-85 (Ind. 1999).  In particular, this statute is constitutional when applied to all plaintiffs able to discover the alleged malpractice and injury within two years from the date of the occurrence.  Garneau, 838 N.E.2d at 1141.  The statute, however, has been determined to be unconstitutional as applied to those plaintiffs unable to discover the alleged malpractice and injury within two years from the date of the occurrence.  Id.

Constitutional

.  Indiana Code § 34-18-7-1 requires a medical malpractice claim be filed within two years of the negligent act when the claimant has discovered the alleged malpractice and the resulting injury, or possessed information that would have lead a reasonably diligent person to such discovery, during the two-year period after the alleged act or omission.  Id.  If such is the case, and the claimant has a reasonable amount of time within which to file a claim before the period expires, the purely occurrence-based limitations period is applicable and constitutional.[1]  Id.  So long as the statute of limitations does not shorten the window of time between the discovery of the alleged malpractice and the expiration of the limitation period so unreasonably that it is impractical for a plaintiff to file a claim at all, it is constitutional as applied to that plaintiff.  Jacobs v. Manhart, 770 N.E.2d 344, 351 (Ind. Ct. App. 2002).  However, the Indiana Supreme Court, quoting the trial court, stated that “a statute of limitations cannot run and expire before the injured party has any way to discover or ascertain that he has been injured or that a tort has occurred.”  VanDusen, 712 N.E.2d at 497.

 

Unconstitutional

.  In situations where plaintiffs cannot reasonably be expected to discover the alleged malpractice until after the limitation period has expired, the occurrence-based statute of limitation is unconstitutional as applied and is replaced with a judicially created discovery-based statute of limitation.  Jacobs, 7701 N.E.2d at 351.  In such a case, the court must then determine when a claimant possessed enough information, that in the exercise of reasonable diligence, should have led to the discovery of the alleged malpractice and resulting injury.  Garneau, 838 N.E.2d at 1141; Jacobs, 770 N.E.2d at 351.  That date is the date the two-year limitations period begins to run for such a claimant.  Garneau, 838 N.E.2d at 1141.  Therefore, Indiana now has a “judicially created discovery-based limitation period to be applied in situations where the occurrence-based statute of limitation is determined to be unconstitutional as applied.”  Jacobs, 770 N.E.2d at 350.  The concern for these types of claimants is that a claimant should not be denied a “meaningful opportunity” to pursue a malpractice claim.  Id. at 351.

 

Date of Discovery.  The determination of when a plaintiff discovered or should have discovered the malpractice and resulting injury is key to deciding the constitutionality of the occurrence-based statute of limitation as applied to a particular plaintiff.  Id.  This determination is to be made by the court on a case-by-case basis, Id. at 352, and the determination can be one of fact or one of law.  In some instances, the question will be subject to resolution on the basis of undisputed facts.  Id.  In other instances, the judge will be required to resolve disputed facts through pre-trial motion practice in order to determine the date upon which the claimant possessed enough information that, in the exercise of reasonable diligence, should have led to the discovery of the alleged malpractice and resulting injury.  Id.

 

When it is undisputed that a plaintiff’s doctor has expressly informed a plaintiff that he/she has a specific injury and that there is a reasonable possibility, if not a probability, that the specific injury was caused by a specific act at a specific time, then the question is one of law and that is the date upon which the two-year period begins to run.  Van Dusen, 712 N.E.2d at 499.  However, a plaintiff’s lay suspicion that there may have been malpractice is not sufficient to trigger the two-year period.  Id.  However, a plaintiff need not know with certainty that malpractice cause his injury.  Id.  These cases are to be decided by the court based upon the particular facts of each case.

 

Fraudulent Concealment[2].  The doctrine of fraudulent concealment is an equitable remedy that operates to bar a defendant from asserting the statute of limitation as a defense.  Palmer v. Gorecki, M.D., 844 N.E.2d 149, 155 (Ind. Ct. App. 2006).  Under this doctrine, a defendant who prevented a plaintiff from discovering an otherwise valid claim, by violation of duty or deception, is estopped from raising a statute of limitations defense.  Id.  There are two types of fraudulent concealment, active and passive, and each has its own applicable statute of limitation.

 

Passive.  Passive (also known as constructive) concealment may be merely negligent and arises when the physician does not disclose to the patient certain material information.  Id.  The doctrine of fraudulent concealment “operates to estop a defendant from asserting a statute of limitations defense when that person, by deception or violation of a duty, has concealed material form the plaintiff thereby preventing discovery of a wrong.”  LeBrun v. Connor, 702 N.E.2d 754, 757 (Ind. Ct. App. 1998).  Before the doctrine of estoppel may be used to bar the defendant’s use of the statute of limitations, the fraud must be of such character as to prevent inquiry, or to elude investigation, or to mislead the party who claims the cause of action.”  Havens v. Ritchey, 582 N.E.2d 792, 795 fn2 (Ind. 1991).  Under this doctrine, the critical event for purposes of determining whether an action was timely filed is the plaintiff’s discovery of facts that should have alerted them that they had a cause of action.  Palmer, 844 N.E.2d at 155.  Therefore, when there is passive concealment, the duty to disclose ceases at the termination of the health care provider/patient relationship or at the time that the plaintiff actually discovers or has a reasonable opportunity to discover the malpractice, whichever occurs first.  Id.  “Equity supplies what equity requires,” thus, a claimant must file suit within a “reasonable time” after learning of the possible malpractice or after discovery of information that should reasonably lead to the discovery of the possible malpractice.  VanDusen, 712 N.E.2d at 497.  The burden is on the plaintiff to establish that she has exercised reasonable diligence to discover the alleged malpractice.  LeBrun, 702 N.E.2d at 757.  A plaintiff learns, or should have learned, of information which would lead to discovery of malpractice when she is informed that she has the condition which she claims was brought on by the malpractice.  Id.

 

Active.  When the concealment is active, however, the period of estoppel “is not affected by the date of termination of the relationship but continues for a reasonable time after the plaintiff discovers the alleged malpractice or discovers information which in the exercise of reasonable diligence would lead to discovery of the malpractice.”  Id.  The principal difference between active and passive fraudulent concealment  “lies in the different points in time at which plaintiffs may commence their malpractice actions.”  Id.  Therefore, whether the fraudulent concealment is active or passive, a plaintiff must initiate an action within a reasonable time after the patient learns of the malpractice, “or discovers information which would lead to the discovery of malpractice if the patient exercised reasonable diligence.”  Id.

 

Continuing Wrong[3].  The doctrine of continuing wrong applies where an entire course of conduct combines to produce an injury.  Palmer, 844 N.E.2d at 156.  The doctrine of continuing wrong is not an equitable doctrine; it is simply a legal concept used to define when an act, omission, or neglect took place.  Havens, 582 N.E.2d at 795.  When conduct is determined to constitute a continuing wrong, the statute of limitations is tolled “so that it does not commence running until the wrongful act ceases.”  LeBrun, 702 N.E.2d at 758.  In order to apply the doctrine, a plaintiff must demonstrate that the alleged injury-producing conduct was of a continuous nature.  Palmer, 844 N.E.2d at 156.  Therefore, when the sole claim of medical malpractice is a failure to diagnose, the omission cannot, as a matter of law, extend beyond the time the physician last rendered a diagnosis.  Id. at 156; Havens, 582 N.E.2d at 795.  Nevertheless, a plaintiff may not sit idly by if he/she discovers facts that alert him/her that there is a cause of action.  Palmer, 844 N.E.2d at 156.  The doctrine of continuing wrong will not prevent the statute of limitations from beginning to run when the plaintiff learns of facts which should lead to the discovery of a cause of action even if the relationship with the tortfeasor continues beyond that point.  Id.

 

The statute of limitations for medical malpractice claimants is found at Indiana Code § 34-18-7-1(b) which provides, in relevant part:

a claim, whether in contract or tort, may not be brought against a health care provider based upon professional services or health care that was provided or that should have been provided unless the claim is filed within two (2) years after the date of the alleged act, omission, or neglect, except that a minor less than six (6) years of age has until the minor’s eighth birthday to file.

 

“This is an ‘occurrence’ statute as opposed to a ‘discovery’ statute.  The time therefore begins to run on the date the alleged negligent act occurred, not on the date it was discovered.”  Brinkman v. Bueter, 879 N.E.2d 549, 553 (Ind. 2008).  Pursuant to this statute, a medical malpractice claim must be filed within two (2) years of the negligent act when the claimant has discovered the alleged malpractice and the resulting injury, or possessed information that would have lead a reasonably diligent person to such discovery, during the two-year period after the alleged act or omission.  Id.  If such is the case, and the claimant has a reasonable amount of time within which to file a claim before the period expires, the purely occurrence-based limitations period is applicable and constitutional.  So long as the statute of limitations does not shorten the window of time between the discovery of the alleged malpractice and the expiration of the limitation period so unreasonably that it is impractical for a plaintiff to file a claim at all, it is constitutional as applied to that plaintiff.  Jacobs v. Manhart, 770 N.E.2d 344, 351 (Ind. Ct. App. 2002).

However, in situations where plaintiffs cannot reasonably be expected to discover the alleged malpractice until after the limitation period has expired, the occurrence-based statute of limitation is unconstitutional as applied and is replaced with a judicially created discovery-based statute of limitation.  Jacobs, 7701 N.E.2d at 351.  In such a case, the court must then determine when a claimant possessed enough information, that in the exercise of reasonable diligence, should have led to the discovery of the alleged malpractice and resulting injury.  Garneau v. Bush, 838 N.E.2d 1134, 1141 (Ind. Ct. App. 2005); Jacobs, 770 N.E.2d at 351.  That date is the date the two-year limitations period begins to run for such a claimant.  Garneau, 838 N.E.2d at 1141.

Such is the case with a failure to diagnose.  Brinkman, 879 N.E.2d at 554.  The statutory period does not begin to run until either the correct diagnosis is made or the patient has sufficient facts to make it possible to discover the alleged injury.  Id.  Thus, the medical malpractice statutory period begins to run on the date of the occurrence of the alleged negligent act, except in those limited situations where it is impossible for plaintiffs to discover the alleged malpractice.  Id.

The Indiana Supreme Court, in Brinkman v. Bueter, found that Plaintiffs who waited until 2000 to file their medical malpractice complaint even though all underlying events occurred in 1995, were barred from bringing those claims as the applicable statute of limitations had passed.  See generally Brinkman, 879 N.E.2d 549 (Ind. 2008).  In that case, a new mother was told that the late discovery of preeclampsia put her at high risk in the event of a future pregnancy.  Id. at 551. The doctors encouraged her sterilization.  Id.  She did not undergo the procedure, and accidentally became pregnant three years later.  During the course of that pregnancy, she learned, for the first time, that her preeclampsia could have been avoided with proper medical treatment and that the advice that she was at risk from a future pregnancy and should undergo sterilization was wrong.  Id. at 552  The Indiana Supreme Court held that the statute of limitations began to run when Plaintiff was informed of the preeclampsia and wrongly advised of her future risk not when she was later told that such advice was wrong.  Id. at 554.  The Court found that nothing prevented her from seeking a second opinion concerning the advice at that time, and a second opinion would have revealed the malpractice.  Id. at 555.  The Court distinguished this type of situation from one in which there is a failure to diagnose a latent condition, or a condition with a long incubation period, because, in that situation, there would be no reason to seek a second opinion, unlike in the case of an incorrect diagnosis of positive findings.  Id.  The Court stated, “[a] plaintiff does not need to be told malpractice occurred to trigger the statute of limitations.”  Id.

3. Health Care Services and Physician/Patient Relationship

Under Indiana law, “Health care” means “an act or treatment performed or furnished, or that should have been performed or furnished, by a health care provider for, to, or on behalf of a patient during the patient’s medical care, treatment, or confinement.”  I.C. § 34-18-2-13.  “Malpractice” is a “tort or breach of contract based on health care or professional services that were provided, or that should have been provided, by a health care provider, to a patient.”  I.C. § 34-18-2-18.  Services that are an integral or essential part of the cause of action for medical malpractice, are professional services if they cannot legally be rendered except by, or under the supervision of, a licensed dentist.  See Meier v. Combs, 263 N.E.2d 194, 199 (Ind. Ct. App. 1970).

Under I.C. § 25-14-1-1, it is unlawful for any person, not duly licensed, to practice dentistry in Indiana.  A person practices dentistry if he “directs and controls the treatment of patients within a place where dental services are performed,” or “extracts human teeth.”  I.C. § 25-14-1-23.  A “health care provider” is an individual licensed or legally authorized by the State of Indiana to provide health care or professional services as, among other things, a dentist.  I.C. § 34-18-2-14.  A “patient” is an individual “who receives or should have received health care from a health care provider, under a contract, express or implied, and includes a person having a claim …as a result of alleged malpractice on the part of a health care provider.”  I.C. § 34-18-2-22.

Where there is no claim of fraudulent concealment, continuing wrong, or other continuing professional relationship, the physician/patient relationship normally terminates on the last date the physician renders medical treatment and/or services to the patient.  See generally Babcock v. Carter, 587 N.E.2d 1320, 1324 (Ind. Ct. App. 1992).  A patient’s bare assertion that he/she continued to rely upon a physician for medical treatment is insufficient as a matter of law to create a factual issue in this regard.  Id.

In Thayer, Ms. Thayer was employed by Lafayette Clinic, Inc., where Defendant Dr. OrRico, a psychiatrist, worked.  Thayer, 792 N.E.2d at 921.  During the course of her employment, Ms. Thayer sought advice from Dr. OrRico concerning her children and her marriage, received advice from Dr. OrRico on parenting and her marriage, and was advised by Dr. OrRico to discontinue the use of medications prescribed by another physiatrist and undergo herbal treatments.  Id. at 926.  The Court of Appeals found that the following factors should be considered when determining whether a therapist-patient relationship existed:  (i) whether the individual consulted with or was examined by a therapist for the purpose of receiving treatment, (ii) whether the therapist made a recommendation to the individual regarding his or her condition or as to any course of treatment, and (iii) whether the therapist performed some affirmative act which would support an inference that he or she consented to the establishment of the therapist-patient relationship.  Id. (emphasis added).  As Indiana law was sparse relative to the creation of the physician-patient relationship, the Court also examined Indiana’s law regarding the existence of an attorney-client relationship.  The Court stated:

In addition, the putative client’s subjective belief that he is consulting a lawyer in his professional capacity and his intention to seek professional advice are important factors that are considered in addressing that issue.  However, “the relationship is consensual, existing only after both attorney and client have consented to its formation….”

 

Id. (emphasis added).  On this bases, the Court found a physician-patient relationship existed between Thayer and OrRico as (i) Thayer sought advice from OrRico, (ii) OrRico consulted with Thayer on “a frequent basis” and “gave her advice,” (iii) and “most importantly,” that OrRico advised Thayer to discontinue the use of medications prescribed by another and to undergo herbal treatments.  Id. (emphasis added).

 

Further, the termination of Plaintiff and Dr. Whitlock’s patient-physician relationship on February 27, 2003 is supported by an analysis under Weldon v. Universal Reagents, Inc., 714 N.E.2d 1104 (Ind. Ct. App. 1999) as well.  If a person does not seek or expect to receive health care from a health care provider when she voluntarily sees said health care provider, there is no physician-patient relationship.  Weldon, 714 N.E.2d at 1109 (citing Payette v. Rockefeller Univer., 220 A.D.2d 69 (N.Y. App. Div. 1996))(a plaintiff who did not consult a Blood Bank as a health care provider, even though the plaintiff underwent procedures traditionally associated with a physician, were not done as a patient with a medical condition; therefore, no physician-patient relationship existed).  If a person does not seek or expect to receive health care from a health care provider any more, the physician-patient relationship ends

The statute of limitations for medical malpractice actions in Indiana is straight forward.  It is an occurrence based statute, not a discovery statute.  A medical malpractice claim must be filed within two (2) years of the negligent act when the claimant has discovered the alleged malpractice and the resulting injury, or possessed information that would have lead a reasonably diligent person to such discovery, during the two-year period after the alleged act or omission.  Brinkman v. Bueter, 879 N.E.2d 549, 553 (Ind. 2008).  If such is the case, and the claimant has a reasonable amount of time within which to file a claim before the period expires, the purely occurrence-based limitations period is applicable and constitutional.  In such situations, the occurrence based statute of limitations is constitutional as applied to that plaintiff.  Jacobs v. Manhart, 770 N.E.2d 344, 351 (Ind. Ct. App. 2002).

As for when the medical malpractice statute of limitations is triggered, the Indiana Supreme Court has said:

[T]he circumstances alerting the patient to the injury or to the potential of malpractice vary widely.  A patient can learn of the fact of disease or injury either from personal knowledge of pain or symptoms or from a professional examination.  In each of these contexts, where the constitutionality of the occurrence-based limitations period as applied to a given case is in issue, the ultimate question becomes the time at which a patient “either (1) knows of the malpractice and resulting injury or (2) learns of facts that, in the exercise of reasonable diligence, should lead to the discovery of the malpractice and the resulting injury.”  Although we have sometimes referred to the critical date as the “discovery date,” we think a more accurate term is “trigger date,” because actual or constructive discovery of the malpractice often postdates the time when these facts are known.  Moreover, the trigger date, unlike a typical discovery date applicable to an accrual of a claim, in most circumstances does not start a fixed limitations period.  Rather, it is the date on which a fixed deadline becomes activated.

 

Herron v. Anigbo, 897 N.E.2d 444, 448-49 (Ind. 2008).

The length of time within which a claim must be filed after a trigger date in an occurrence-based statute varies with the circumstances.  Id. at 449.  A plaintiff whose trigger date is after the original limitations period has expired may institute a claim for relief within two years of the trigger date.  Id. (Emphasis added). However, if the trigger date is within two years after the date of the alleged malpractice, the plaintiff must file before the statute of limitations has run if possible in the exercise of due diligence. Id. (Emphasis added).  If the trigger date is within the two-year period but in the exercise of due diligence a claim cannot be filed within the limitations period, the plaintiff must initiate the action within a reasonable time after the trigger date.  Id.  The determination of the trigger date may often be resolved as a matter of law.  Id.

The trigger date becomes a matter of law when it is clear that the plaintiff knew, or should have known, of the alleged symptom or condition, and facts that in the exercise of reasonable diligence would lead to discovery of the potential malpractice.  Id.  For example, the trigger date is established as a matter of law when a patient is told by a doctor of a “reasonable possibility, if not a probability, that the specific injury was caused by a specific act at a specific time.” Id.  The date is also set as a matter of law when there is undisputed evidence that leads to the legal conclusion that the plaintiff should have learned of the alleged malpractice and there is no obstacle to initiating litigation.  Id.

  1. Reasonable Diligence in Pursing a Medical Malpractice Claim

 

If the “trigger date” is within the two-year period, then the court must examine whether the plaintiff had sufficient time, with the exercise of reasonable diligence, to file a claim within the two-year period.  In many malpractice cases the injury by its nature is known to the patient and suggests that there may have been malpractice.  Herron, 897 N.E.2d at 449.  If so, even under an accrual or discovery-based limitations period, reasonable diligence requires pursing the facts to determine whether there is a claim.  Id.  Reasonable diligence requires more than inaction by a patient who, before the statute has expired, does or should know of both the injury or disease and the treatment that either caused or failed to identify or improve it, even if there is no reason to suspect malpractice.  Id.  As a matter of law, the statute requires such a plaintiff to inquire into the possibility of a claim within the remaining limitations period, and to institute a claim within that period or forego it.  Id.

In Coffer v. Arndt, the Plaintiff stopped treatment with the defendant in October 1995, when defendant referred plaintiff to a different physician, a specialist.  Coffer, 732 N.E.2d at 819.  Plaintiff was then informed, in December 1995, that he had glaucoma and had had it for several years.  Id.  However, plaintiff did not sue defendant until December 1997.  Id.  The court held that the 22 month time between the time plaintiff had sufficient information to reasonably inquire about possible medical malpractice (December 2005) until the two-year statute of limitation ran (October 1997) was sufficient time to file a medical malpractice claim.  Id. at 821.  Therefore, plaintiff’s claim was barred as it was filed past the two year statute of limitations.

Likewise, in Overton v. Grillo, plaintiff had a routine mammograph on July 7, 1999, and was told by defendant that she had no malignancies.  Overton v. Grillo, 896 N.E.2d 499, 501 (Ind. 2008).  On November 1, 2000 plaintiff underwent a mastectomy during which adjacent lymph nodes were found to be cancerous.  Id.  However, it was not until October 11, 2001, when plaintiff claims she was first advised of the possibility of a potential claim of medical negligence.  Id.  Plaintiff then filed her claim on October 19, 2001.  Id.  The Indiana Supreme Court held that although plaintiff was not told of the possibility of a malpractice claim until October 2001, a plaintiff need not be advised of the possibility of malpractice where it should be obvious that it might be present.  Id. at 503.  The Court went on to hold that nothing prevented the plaintiff from filing in the nine (9) months remaining in the limitations period, which began on July 7, 1999 and was triggered in November 2000 when the cancer was detected.  Id. 504.

In Herron, plaintiff’s claims were based on negligence relative to a May 6, 2002 surgery.  Herron, 897 N.E.2d at 452.  After the operation, plaintiff had difficulty speaking and suffered from infection and pulmonary difficulties that required the use of a ventilator.  Id. at 447.  He was informed in November 2003, that his “condition [had] deteriorated since his [surgery], and that a likely cause of the deterioration was negligent follow-up care.” Id.  As of January 2004, plaintiff was unable to be transported by car and required the use of oxygen.  Id.  Plaintiff filed his complaint on December 7, 2004.  Id.  The Indiana Supreme Court found that nothing prevented plaintiff from investigating whether he may have had a claim prior to the running of the two-year statute of  limitation (May 2002).  Id. at 453.  Even though plaintiff was physically incapacitated at times, he was not ignorant of his injury, its failure to improve, or that he had been treated by defendant.  Id.  The court found:

…claims based on negligence in the May 6, 2002 surgery are barred because Herron failed as a matter of law to pursue his claim with reasonable diligence within the period required by the statute.  An occurrence-based limitations period can produce harsh results.  If Herron’s surgery was below the standard of care, this is such a case.  Herron’s condition was and is severe, and it is understandable that his focus was on medical outcomes, not legal remedies, in the more than two years following the surgery.  But the legislature has prescribed an occurrence-based limitations period, and Herron and all other patients are charged with knowledge of the law, however unrealistic that assumption may be in a given case.

 

Id.

Finally, The Indiana Supreme Court, in Brinkman v. Bueter, found that Plaintiffs who waited until 2000 to file their medical malpractice complaint, even though all underlying events occurred in 1995, were barred from bringing those claims as the applicable statute of limitations had passed.  See generally Brinkman, 879 N.E.2d at 549.  In that case, a new mother was told that the late discovery of preeclampsia put her at high risk in the event of a future pregnancy.  Id. at 551. The doctors encouraged her sterilization.  Id.  She did not undergo the procedure, and accidentally became pregnant three years later.  During the course of that pregnancy, she learned, for the first time, that her preeclampsia could have been avoided with proper medical treatment and that the advice that she was at risk from a future pregnancy and should undergo sterilization was wrong.  Id. at 552  The Indiana Supreme Court held that the statute of limitations began to run when Plaintiff was informed of the preeclampsia and wrongly advised of her future risk (1995) not when she was later told that such advice was wrong (1998).  Id. at 554.  The Court found that nothing prevented her from seeking a second opinion concerning the advice in 1995, and a second opinion would have revealed the malpractice.  Id. at 555.  The Court distinguished this type of situation from one in which there is a failure to diagnose a latent condition, or a condition with a long incubation period, because, in that situation, there would be no reason to seek a second opinion, unlike in the case of an incorrect diagnosis of positive findings.  Id.  Again, “[a] plaintiff does not need to be told malpractice occurred to trigger the statute of limitations.”  Id.

 

 


[1] If a plaintiff discovers a malpractice claim within a very short time before the expiration of the limitation period (an “eve of midnight discovery”), such is to be addressed by the court on a case-by-case basis to determine whether said plaintiff had a reasonable amount of time to file before the limitation period expired.  Jacobs v. Manhart, 770 N.E.2d 344, 351 (Ind. Ct. App. 2002).

[2] This doctrine is used for equitable considerations to estop a health care provider from asserting a statute of limitations defense so a potential claimant is not unfairly denied an opportunity to pursue a medical malpractice action.

[3] This doctrine is applied to determine when the date of alleged malpractice occurred.