Accrual of Personal-Injury Claims for Defective Pelvic Mesh: Convergence of Manifest-Injury and Discovery Rules

Introduction

This case arises from Rowena and Robert Crowe’s lawsuit against Johnson & Johnson and its subsidiary Ethicon, Inc., alleging that Ethicon’s transvaginal tape obturator (“TVT-O”) and Prolift pelvic floor repair mesh devices caused Mrs. Crowe severe pelvic pain and related injuries. The Crowes first underwent mesh implantation in July 2007, experienced worsening symptoms from 2010 onward, and ultimately had the mesh removed in June 2015. They filed suit in August 2015. Johnson & Johnson moved for summary judgment, arguing that the Crowes’ claims were time-barred under Alabama’s two-year statute of limitations. The district court granted summary judgment, finding no true conflict under New Jersey choice-of-law principles because the Crowes’ claims also would be untimely under New Jersey’s “discovery rule.” The Eleventh Circuit affirmed.

Summary of the Judgment

On appeal, the Eleventh Circuit addressed two core issues:

Whether Alabama’s manifest-injury rule or New Jersey’s discovery rule governs the accrual of the Crowes’ personal-injury claims after a § 1404(a) transfer for convenience.
Whether, under either state’s rule, the Crowes’ August 20, 2015 complaint was timely.

The court concluded that:

Under Alabama law, a cause of action accrues when an injury is “manifestly present,” which occurred as early as August 2010 when Mrs. Crowe reported pelvic pain linked to the mesh.
Under New Jersey law, a cause of action accrues upon discovery—or reasonable awareness—of a possible causal link between the injury and the alleged wrongdoer. By October 2012, Mrs. Crowe had sought release of part of the mesh, demonstrating awareness of that possibility.
Because both analyses yield the same outcome—untimeliness—the court found no “true conflict” under New Jersey choice-of-law rules and affirmed the grant of summary judgment.

Analysis

1. Precedents Cited

McCarrell v. Hoffmann-La Roche, Inc. (N.J. 2017): Established New Jersey’s approach to choice-of-law for statutes of limitations, requiring a “true conflict” (outcome determinative) before applying foreign law.
P.V. ex rel. T.V. v. Camp Jaycee (N.J. 2008): Reinforced the “true conflict” test in the statute-of-limitations context under New Jersey law.
Rowe v. Hoffman-La Roche, Inc. (N.J. 2007): Held that, absent a true conflict, New Jersey applies its own statute of limitations to cases transferred under § 1404(a).
Griffin v. Unocal Corp. (Ala. 2008): Articulated Alabama’s “manifest-injury” rule, under which accrual occurs when observable symptoms emerge.
Savage v. Old Bridge-Sayreville Med. Grp. (N.J. 1993): Explained New Jersey’s discovery rule—accrual upon discovery or reasonable awareness of a claim’s basis.
Vispisiano v. Ashland Chem. Co. (N.J. 1987) and Lapka v. Porter Hayden Co. (N.J. 2000): Clarified that “some reasonable medical support”—not full confirmation—is sufficient to trigger accrual under the discovery rule.

2. Legal Reasoning

The court’s reasoning unfolded in several steps:

Choice-of-Law Framework: Under New Jersey law, a foreign statute of limitations is applied only when a “true conflict” exists—i.e., choosing between state A’s or state B’s limitations period would change the outcome. Otherwise, the forum applies its own law (Rowe, McCarrell).
Alabama Accrual Rule: ALA. CODE §§ 6-2-30(a), ‑38(l) sets a two-year limit that begins to run when the injury is “manifestly present,” meaning contractible symptoms are medically identifiable (Griffin).
New Jersey Accrual Rule: N.J. STAT. ANN. § 2A:14-2(a) imposes a two-year limit, but accrual is governed by the “discovery rule”: a claim accrues once the plaintiff discovers—or should have discovered through reasonable diligence—that a third party’s conduct may have caused the injury (Savage, Vispisiano).
Application to Facts:
- Under Alabama law, by August 2010 Mrs. Crowe had manifest pelvic symptoms and voiced concern to Dr. Brown that the mesh might be responsible.
- Under New Jersey law, by October 2012 Mrs. Crowe had a portion of the Prolift mesh surgically released at her request, confirming her awareness of a possible causal link. Her contemporaneous records show repeated inquiries about mesh causation (August 2010, January 2011, May 2012, October 2012).
No Genuine Factual Dispute: Mrs. Crowe’s deposition denials (“I do not recall”) did not override the clear medical records documenting her express concerns about mesh causation and her decision to remove mesh despite her doctors’ uncertainty.
No True Conflict: Because both rules produced the same result—accrual more than two years before the August 2015 filing—the court needed no choice-of-law decision and applied New Jersey law by default, confirming untimeliness.

3. Impact

This decision carries several practical implications:

Unified Outcome in MDL Transfers: Courts in the Eleventh Circuit may apply forum-state limitations rules by default where foreign rules do not change outcomes.
Heightened Diligence for Device Plaintiffs: Injured patients and their counsel must act promptly once there is any medical suggestion of device causation—even if diagnosis remains uncertain.
Choice-of-Law Clarity: New Jersey’s “true conflict” requirement will limit forum shopping in transfers under 28 U.S.C. § 1404(a).
Medical Documentation Importance: Contemporaneous records noting patient concerns and differential diagnoses can decisively establish accrual dates.

Complex Concepts Simplified

Statute of Limitations: A deadline by which a lawsuit must be filed. Missing it means losing the right to sue.
Accrual: The moment when the clock starts running on the statute of limitations. In personal-injury cases, accrual can depend on injury manifestation or discovery of the wrong.
Manifest-Injury Rule: Under Alabama law, accrual occurs when the injury is observable and medically identifiable, regardless of the plaintiff’s subjective awareness of cause.
Discovery Rule: Under New Jersey law, accrual occurs when the plaintiff knows—or should know through reasonable diligence—that the defendant’s conduct might have caused the injury.
True Conflict: A choice-of-law doctrine requiring that applying one state’s limitations law rather than another’s would change the case’s outcome before a court adopts the foreign law.

Conclusion

The Eleventh Circuit’s decision in Rowena K. Crowe v. Johnson & Johnson underscores the critical role statutes of limitations play in medical device litigation. It clarifies that, whether under Alabama’s manifest-injury rule or New Jersey’s discovery rule, a plaintiff’s repeated medical inquiries and documented requests to remove a device establish accrual. By requiring a “true conflict” before transplanting foreign limitations periods, the court fortifies the forum-state’s authority and simplifies choice-of-law analysis. This judgment serves as a cautionary tale for potential claimants to monitor and address symptoms—and seek legal advice—as soon as any reasonable suspicion of device causation arises.