Expanded Tolling Under the FTCA’s Continuous Treatment Doctrine in Carroll v. United States

Introduction

Carroll v. United States (2d Cir. Apr. 25, 2025) addresses the scope of the “continuous treatment doctrine” as a tolling exception to the Federal Tort Claims Act’s two-year statute of limitations. Pro se plaintiff Robert B. Carroll sued the United States, alleging that Veterans Affairs medical staff failed to diagnose and treat deep vein thrombosis (DVT) in visits to Stratton Veterans Hospital in 2015 and 2017. The district court dismissed his FTCA claim as time-barred under Fed. R. Civ. P. 12(b)(6). On appeal, Carroll argued that his ongoing anticoagulation treatment, concluding in February 2019, tolled the limitations period. The Second Circuit vacated and remanded, holding that dismissal at the pleading stage was improper because Carroll had plausibly alleged continuous care sufficient to invoke tolling.

Summary of the Judgment

The Second Circuit reviewed de novo the district court’s dismissal for failure to state a claim on statute-of-limitations grounds. It held:

FTCA claims must generally be presented in writing to the appropriate federal agency within two years of accrual (28 U.S.C. § 2401(b)).
Where a plaintiff remains in continuing care for the same injury that gives rise to the claim, the statute of limitations may be tolled until the end of treatment (the “continuous treatment doctrine”).
The district court erred by requiring that treatment be provided by the exact same doctor. Under Second Circuit authority, continuous care by the hospital or its staff suffices.
Carroll’s allegations—that he underwent anticoagulation treatment from November 2017 until February 19, 2019—plausibly invoke the doctrine, so dismissal was premature.

Accordingly, the Court vacated the dismissal and remanded for further factual development.

Analysis

1. Precedents Cited

The Court’s decision draws on a line of FTCA and tolling cases:

Ulrich v. Veterans Admin. Hosp., 853 F.2d 1078 (2d Cir. 1988): First articulated the continuous treatment doctrine in FTCA context, explaining that a patient should not have to interrupt corrective care to sue.
Camire v. United States, 535 F.2d 749 (2d Cir. 1976): Reinforced that continuous treatment by the same hospital or its associates suffices; the requirement is continuity of care, not continuity of a single doctor.
United States v. Kwai Fun Wong, 575 U.S. 402 (2015): Confirmed that § 2401(b) is non-jurisdictional and thus subject to equitable tolling.
Syms v. Olin Corp., 408 F.3d 95 (2d Cir. 2005): Clarified FTCA accrual rules—claims accrue when injury is or should be discovered.
Castagna v. Luceno, 744 F.3d 254 (2d Cir. 2014): Established de novo review of statutes of limitations dismissals.
Bertin v. United States, 478 F.3d 489 (2d Cir. 2007): Reminded courts to construe pro se pleadings liberally.

2. Legal Reasoning

The Court’s reasoning can be broken down into key steps:

Standard of Review: De novo for Rule 12(b)(6) dismissals and statutory interpretations; pro se filings read liberally.
FTCA Tolling Framework: Under § 2401(b), FTCA claims must be filed within two years of accrual but tolling doctrines apply because the limitation is non-jurisdictional.
Continuous Treatment Doctrine: A plaintiff under ongoing care for the same injury may toll accrual until the end of that care. The doctrine is grounded in fairness—patients should not have to sue their caregivers while still receiving treatment.
Scope of “Continuous Treatment”: The district court had narrowed the doctrine by demanding treatment by the identical physician. The Second Circuit rejected that requirement, emphasizing that continuity of the treating institution or care team suffices.
Plausibility of Tolling Allegations: Carroll alleged anticoagulation from late 2017 through February 19, 2019. Construed liberally, that amounts to continuous treatment at Stratton Veterans Hospital, so his FTCA filing in January 2021 falls within two years of treatment end.

3. Impact on Future Cases

Carroll expands and clarifies tolling under the FTCA:

District courts must accept at the pleading stage allegations of ongoing care by a hospital or facility, even if multiple providers are involved.
Pro se plaintiffs receive liberal construction, particularly when equitable tolling doctrines are at issue.
FTCA litigation over medical malpractice and negligence will require careful factual inquiry into post-diagnosis treatment regimens.
The decision may reduce premature dismissals, ensuring that claimants under extended care can pursue their remedies without procedural bars.

Complex Concepts Simplified

FTCA: A federal statute that waives sovereign immunity for certain tort claims against the United States, but imposes a two-year deadline to present a claim to the relevant agency.
Accrual: The moment when a legal claim arises—typically when injury is discovered or should have been discovered by reasonable diligence.
Continuous Treatment Doctrine: An equitable tolling rule allowing the statute of limitations to pause while a plaintiff is still receiving care for the same injury from the same hospital or care provider, avoiding the absurdity of suing one’s doctors mid-treatment.
Pro Se Liberal Construction: Courts interpret filings by litigants without counsel broadly, giving them every reasonable benefit in stating a claim.

Conclusion

Carroll v. United States marks a significant reaffirmation and expansion of the continuous treatment doctrine under the FTCA. The Second Circuit’s vacatur and remand make clear that ongoing care by a hospital or its staff—even if delivered by multiple providers—tolls the FTCA’s statute of limitations until treatment ends. This decision protects patients who cannot interrupt necessary medical care to pursue legal claims, promotes fuller adjudication of meritorious FTCA suits, and guides lower courts to apply tolling doctrines with fidelity to fairness and precedent.