The Supreme Court of Virginia has weighed in on a complex medical malpractice case, ruling in favor of Dr. Shannon J. Cothran and reinstating the dismissal of Renee Jauregui’s lawsuit. The core of the dispute centered on Virginia’s “continuing treatment rule,” an exception that can pause the clock on the two-year statute of limitations for medical claims. The Court clarified the meaning of “substantially uninterrupted” in this context, ultimately agreeing with the trial court that a nearly ten-month gap between appointments constituted a break too significant to qualify for the exception.
The Initial Claim and the Statute of Limitations Hurdle
The case began in June 2021 when Renee Jauregui sued her former OB/GYN, Dr. Cothran. Jauregui alleged that during several pregnancy-related visits between May and October 2018, she repeatedly mentioned a breast lump, but Dr. Cothran dismissed her concerns, suggesting it was normal for pregnancy and unnecessary to test. The critical turning point came in August 2019, when a follow-up appointment revealed the lump was, in fact, metastatic breast cancer.
Because the initial alleged malpractice occurred in 2018, Dr. Cothran argued that the two-year statute of limitations had expired before Jauregui filed her complaint in 2021. Jauregui countered by invoking the continuing treatment rule. The parties agreed that any claims related to the 2018 appointments were barred unless the rule applied, which hinges on whether there was a “continuous and substantially uninterrupted course of examination and treatment.”
Conflicting Testimonies and the Trial Court’s View
At the evidentiary hearing, the recollections of the doctor and patient sharply diverged. Jauregui testified that Dr. Cothran examined the lump during multiple 2018 visits, diagnosing it at one point as a clogged milk duct and assuring her at the October 2018 postpartum visit that it would resolve with continued pumping. Crucially, Jauregui claimed Dr. Cothran told her to monitor the lump and call the office if anything changed.
Dr. Cothran denied ever examining the lump or diagnosing it as a clogged duct, stating she never expected to see Jauregui again after October 2018.
The trial court sided with Dr. Cothran, sustaining the plea in bar (the motion to dismiss based on the statute of limitations). The judge found a fundamental lack of “continuous and substantially uninterrupted course of examination and treatment.” The trial court emphasized that there was “no medical treatment at all” for the lump and that Jauregui’s instruction to “call the office if she saw any changes” was not a continuous course of examination, but rather a “substantially interrupted course.”
The Court of Appeals Steps In
The Court of Appeals reversed the trial court’s decision in an unpublished opinion. The appellate court believed the trial court had misinterpreted the continuing treatment rule by focusing too heavily on the *existence* of specific treatment. Citing the precedent set in *Farley v. Goode*, the Court of Appeals argued that the focus should be on whether Jauregui returned “pursuant to Dr. Cothran’s instructions, for further examination of the same condition.” Since Jauregui followed the doctor’s instructions to monitor the lump and returned when she noticed a change, the Court of Appeals found a direct causal link that satisfied the requirement for a continuous course of examination.
Virginia Supreme Court Clarifies the Rule
Dr. Cothran appealed this reversal, leading the Supreme Court of Virginia to examine the nuances of the continuing treatment rule itself.
The Supreme Court first reiterated the rule: the statute of limitations doesn’t start running until the “improper course of examination and treatment if any, for the particular malady terminates.”
The Court then addressed a potential source of confusion regarding the rule’s requirements. While it is called the “continuing treatment rule,” the Court confirmed that treatment is not mandatory; the rule applies if there is a continuous course of *either* examination *or* treatment.
However, the central issue became the interpretation of the phrase “substantially uninterrupted.” The Court of Appeals had essentially defined “substantially uninterrupted” using the definition for “continuous treatment” established in past cases—meaning the treatment or examination must relate to the “same or related illnesses or injuries.”
The Supreme Court found this conflation to be an error. If “continuous treatment” already means the relationship concerns the same injury, then “substantially uninterrupted” must mean something distinct to avoid redundancy.
“We hold that the Court of Appeals erred when it used the definition ‘continuous treatment’ interchangeably with ‘substantially uninterrupted,’” the opinion stated.
The justices turned to plain dictionary definitions. “Uninterrupted” means continuous, while “substantial” means considerable in extent. Taken together, the phrase requires a relationship that is “mostly, but not necessarily entirely, continuous.” It introduces a “layer of reasonableness into the continuity requirement.”
The Ten-Month Gap Was Too Long
Applying this clarified standard, the Supreme Court sided with the trial court’s factual findings. The trial court had noted that at the end of the October 2018 visit, both parties acted as if the relationship regarding the lump had ended, with neither party “forecasting” any need for further care.
While the Court acknowledged that the length of time between appointments is not the sole factor—noting that *Farley* involved appointments more than a year apart—it determined that the nearly ten-month gap, coupled with the reasonable belief that the matter was concluded, constituted a substantial interruption under the circumstances of this case.
“Under these circumstances, we cannot say that the trial court’s finding that this amounted to a substantial interruption in the course of examination was plainly wrong or without evidence to support it,” the Court concluded.
The Supreme Court reversed the Court of Appeals’ decision and reinstated the trial court’s order sustaining Dr. Cothran’s plea in bar, meaning Jauregui’s medical malpractice claim is officially barred by the statute of limitations.