## Facts

- Maria Solorzano Arroyo received prenatal care in 2002–2003 at Erie Family Health Center, a federally supported clinic whose physicians were treated as federal employees for tort liability purposes.
- The clinic did not perform certain routine late-pregnancy tests, including testing for Group B Streptococcus (GBS).
- Christian Arroyo was born prematurely in 2003 and soon showed signs consistent with neonatal infection.
- The delivery and postdelivery providers failed to timely diagnose and treat the infection, including failing to promptly administer antibiotics despite symptoms warranting treatment when maternal GBS status is unknown.
- Christian suffered severe and permanent brain injuries from the untreated infection.
- The parents were not informed at discharge that timely diagnosis and treatment could have prevented the injuries and initially understood the condition as an unexplained complication of prematurity.
- The parents later learned, during the birth of a second child, that Christian’s injuries likely resulted from untreated GBS and were preventable.
- In 2005, the family filed an Illinois medical-malpractice suit; after learning the federal status of the providers, they filed an administrative claim with HHS, which was denied in 2006.
- The United States was substituted as defendant under the FTCA; after a bench trial, the district court found negligence and awarded over $29 million, rejecting the government’s limitations defense.

## Issues

1. When does an FTCA medical-malpractice claim accrue under 28 U.S.C. § 2401(b): at manifestation of injury, or when a reasonable plaintiff discovers (or should discover) both the injury and its government-related cause?
2. Whether the parents, exercising reasonable diligence, should have discovered the government-related cause of Christian’s injuries within two years of his birth.

## Decision

- The Seventh Circuit affirmed the judgment for the plaintiffs.
- The court held that an FTCA medical-malpractice claim accrues when a reasonable person discovers, or with reasonable diligence should discover, both the injury and its government-related cause.
- The court upheld the district court’s finding that the parents did not have sufficient information to connect Christian’s injuries to preventable medical error, and thus to a claim governed by the FTCA, until later.
- Because the administrative claim was presented within two years of accrual and suit followed the agency denial as required, the claim was timely under § 2401(b).

## Legal Principles

- FTCA claim accrual is governed by federal law, even when state law supplies the underlying negligence standard.
- Under the FTCA discovery rule, a medical-malpractice claim accrues when the plaintiff knows, or should know through reasonable diligence, the existence of the injury and facts indicating a government-related causal connection.
- Knowledge of an injury alone does not start the limitations period if the plaintiff lacks sufficient information to suspect that negligent medical care caused the harm.
- Reasonable diligence is assessed in context; lay plaintiffs may reasonably rely on what medical professionals tell them (or fail to tell them) when determining whether they should suspect malpractice.

## Conclusion

The Seventh Circuit held that the parents’ FTCA claim accrued only when they reasonably discovered that their child’s brain injury was attributable to preventable, government-attributable medical negligence, making their administrative filing and subsequent FTCA action timely and leaving the district court’s liability and damages award intact.


Arroyo v. United States, 656 F.3d 663 (7th Cir. 2011)