Massachusetts General Laws Chapter 260, Section 4 governs the medical malpractice statute of limitations in the Commonwealth, establishing a dual-deadline framework: claims must be filed within three years after the cause of action accrues under a discovery standard, but in no event more than seven years after the allegedly negligent act or omission. These requirements operate alongside other state-level rules that influence medical malpractice litigation, including Massachusetts's tribunal screening requirements and statutory damage caps.
This article explains Massachusetts's timing requirements for medical malpractice actions, including discovery rule requirements, the seven-year statute of repose, recognized tolling exceptions, and recent judicial interpretations affecting claim timing.
Core Rules for Medical Malpractice Statute of Limitations in Massachusetts
The statute establishes multiple critical components governing when claims must be filed, how discovery affects accrual, and which healthcare providers and claims fall within the statute's scope.
Dual-Deadline Structure
The statute imposes two independent time limits running simultaneously:
- Claims must be commenced within three years after the cause of action accrues under the discovery rule.
- No action may be commenced more than seven years after the occurrence of the act or omission forming the basis of the claim.
Whichever deadline expires first controls the filing window.
Statute of Repose
The seven-year outer limit operates as an absolute statute of repose, running from the date of the allegedly negligent act rather than from discovery. Only two statutory exceptions permit claims beyond seven years:
- Foreign object exception: Actions based on the presence of a foreign object not intended for therapeutic or diagnostic purpose.
- Minority tolling for children under six: Claims may be filed until the child's ninth birthday.
The Supreme Judicial Court in Harlfinger v. Martin, 435 Mass. 38 (2001), strictly enforced this provision, rejecting arguments that continuing treatment could extend the repose period.
Discovery Rule Requirements
Under Massachusetts law, a cause of action accrues when the plaintiff knows or reasonably should have known of:
- The injury.
- Its causal connection to the defendant's alleged malpractice.
The discovery standard applies a constructive notice test focusing on what a reasonably diligent plaintiff should have known, requiring the plaintiff to demonstrate that the injury and its causal connection could not have been discovered through reasonable diligence.
Scope of Professional Negligence
Mass. Gen. Laws ch. 260, § 4 applies specifically to "actions of contract or tort for malpractice, error or mistake" involving:
- Physicians, surgeons, dentists, optometrists, hospitals, and sanitoria.
- Claims arising from professional services by these enumerated providers.
- Negligent acts or omissions in the rendering of professional care.
Administrative failures or premises liability claims may fall outside this statute and instead be governed by the general three-year tort limitations period under Mass. Gen. Laws ch. 260, § 2A.
Tolling Exceptions That Affect Medical Malpractice Statute of Limitations in Massachusetts
Several tolling doctrines may extend or suspend the limitations period, though their interaction with the seven-year statute of repose varies significantly depending on the exception invoked.
1. Minority Tolling
Mass. Gen. Laws ch. 260, § 4 provides specialized minority tolling compared to general personal injury rules:
- Children under age six: Claims must be filed before the child's ninth birthday.
- Ages six to seventeen: Standard three-year discovery rule applies, with parents or guardians required to file within three years of knowing or reasonably discovering the injury's causal connection to negligent treatment.
The ninth birthday rule represents one of only two exceptions to the seven-year statute of repose. These limits reflect a stricter approach than other tort claims, which typically toll until age eighteen under Mass. Gen. Laws ch. 260, § 7.
2. Mental Incapacity Tolling
Mass. Gen. Laws ch. 260, § 7 tolls the limitations period during periods of mental incapacity. To qualify, the plaintiff must show:
- A mental condition that prevented understanding legal rights at the time the cause of action accrued.
- Inability to take legal action or direct counsel.
- Competent evidence demonstrating incapacity, as established in Heck v. Commonwealth, 397 Mass. 336 (1986).
The interaction between mental incapacity tolling and the seven-year statute of repose remains judicially unresolved for adult incapacitated plaintiffs. Multiple tolling provisions can apply simultaneously, as established in Boudreau v. Landry, 404 Mass. 528 (1989), where both minority tolling and mental incapacity tolling operated concurrently for mentally incapacitated minors.
3. Fraudulent Concealment
Mass. Gen. Laws ch. 260, § 12 tolls the statute during periods when the defendant fraudulently concealed the cause of action. Elements generally include:
- Affirmative acts of concealment that prevented discovery.
- Knowledge of the concealed facts by the defendant.
- Plaintiff's excusable ignorance of the cause of action.
- A causal link between concealment and delayed filing.
This doctrine is applied strictly. The Supreme Judicial Court in Joslyn v. Chang, 445 Mass. 344 (2005), held that fraudulent concealment does not toll the seven-year statute of repose—only the three-year discovery period.
4. Foreign Object Exception
Mass. Gen. Laws ch. 260, § 4 provides that the seven-year statute of repose shall not apply to actions based upon the presence in the body of a foreign object not intended to have a therapeutic or diagnostic purpose.
- Traditionally applied to surgical sponges, instruments, or clamps.
- When it applies, the three-year discovery period runs from discovery of the object, regardless of when the procedure occurred.
This is the sole statutory exception capable of extending the repose period. The Supreme Judicial Court in Joslyn v. Chang, 445 Mass. 344 (2005), emphasized that "the fact that the Legislature specified one exception strengthens the inference that no other exception was intended."
5. Continuous Treatment Doctrine
The Supreme Judicial Court recognized the continuous treatment doctrine in Parr v. Rosenthal, 475 Mass. 368 (2016). Tolling generally requires:
- Ongoing treatment from the same physician who allegedly committed malpractice.
- Treatment for the same or related underlying condition.
- A continuous, unbroken treatment relationship.
- The patient's "innocent reliance" on the physician who is treating them properly.
Tolling terminates when the physician ceases treating the patient for the relevant condition, or when the patient acquires actual knowledge that the physician's negligence caused harm. The doctrine does not extend to "treatment team" scenarios where the allegedly negligent physician has ceased direct involvement. Critically, the continuous treatment doctrine tolls only the three-year discovery rule period—not the seven-year statute of repose.
How Massachusetts Courts Interpret Medical Malpractice Statute of Limitations Rules
Massachusetts appellate courts have addressed several interpretive questions regarding the statute of limitations framework, establishing critical guidance for calculating repose periods in extended treatment relationships.
Bellmar v. Moore — Statute of Repose in Extended Treatment Relationships
The Supreme Judicial Court in Bellmar v. Moore, 495 Mass. 578 (2025), held that the seven-year statute of repose does not bar claims if later negligent acts occurred within the seven-year period, even if earlier negligent acts occurred outside the repose period. This establishes that courts must examine each allegedly negligent act separately rather than applying the repose period to the treatment relationship as a whole.
The case arose from a ten-year patient-physician relationship in which the decedent's primary care physician failed to order follow-up cardiac testing after an abnormal 2006 EKG. The patient died from ventricular arrhythmia in 2016. The court held that the decedent's morbid obesity, hypertension, and other risk factors warranted cardiac evaluation at subsequent appointments regardless of the earlier EKG—establishing that each appointment constituted its own "definitely established event" from which a separate repose period runs.
Joan Moran v. Carolyn Benson — Act-by-Act Repose Analysis
The Massachusetts Appeals Court in Joan Moran v. Carolyn Benson, 100 Mass. App. Ct. 744 (2022), held that the statute of repose barred claims where the plaintiff attempted to characterize ongoing treatment visits as separate negligent acts. The court distinguished between true independent acts of negligence and mere continuation of an initial failure to diagnose.
The plaintiff's 2011 MRI revealed multiple sclerosis, but her physicians failed to inform her and continued treating her for migraines. When she filed suit in 2019, the court rejected her argument that each subsequent appointment constituted separate negligence, holding these visits were "nothing more than the defendants' acts of continuing treatment." The Supreme Judicial Court's subsequent Bellmar decision distinguished Moran by emphasizing that truly independent acts—those constituting malpractice regardless of prior negligent acts—remain actionable within their own repose periods.
Parr v. Rosenthal — Continuous Treatment Doctrine
The Supreme Judicial Court in Parr v. Rosenthal, 475 Mass. 368 (2016), explicitly recognized the continuous treatment doctrine, establishing that tolling continues while a patient remains under ongoing care from the same physician for the same condition. The doctrine ends when that physician ceases treatment or when the patient acquires actual knowledge that the physician's negligence caused harm.
The court declined to extend the doctrine to "treatment team" scenarios where the allegedly negligent physician had ceased direct involvement, reasoning this would risk swallowing the statute of limitations entirely. Critically, the continuous treatment doctrine tolls only the three-year discovery rule period—not the seven-year statute of repose, which remains an absolute outer limit regardless of ongoing treatment relationships.
Recent Updates to Medical Malpractice Statute of Limitations Laws in Massachusetts
No legislative amendments to Mass. Gen. Laws ch. 260, § 4 were enacted between 2022 and 2025. The three-year discovery period and seven-year statute of repose framework have remained unchanged throughout this period.
The most significant judicial development was the Supreme Judicial Court's March 2025 decision in Bellmar v. Moore, which clarified the act-by-act analysis requirement for extended treatment relationships. This decision, combined with the 2022 Appeals Court decision in Joan Moran v. Carolyn Benson, provides clear appellate guidance for cases requiring separate repose calculations for each allegedly negligent act.
What This Means for Medical Malpractice Filing Deadlines in Massachusetts
Compliance with Massachusetts medical malpractice deadlines requires tracking both the three-year discovery rule period and the seven-year absolute statute of repose under M.G.L. c. 260, § 4, with the additional requirement of providing 182-day pre-suit notice to healthcare providers under M.G.L. c. 231, § 60L. Accurate identification of treatment dates, discovery timing, and the chronology of allegedly negligent acts determines available filing windows.
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