Dayton Appeals Court Revives Brain-Injury Malpractice Case Thrown Out as 'Too Late'

Published December 16, 2025 · Ohio Appeals Courts

Imagine waking up in an intensive care unit with no memory of how you got there. For weeks afterward your thoughts are scrambled, and you lose track of what you were saying in the middle of a sentence. Meanwhile, without your knowing it, a legal clock is running, and Ohio gives patients only one year to bring a medical claim.

That is the situation a Miami Valley Hospital patient described to the courts. On November 14, 2025, the Second District Court of Appeals reversed the dismissal of her malpractice case and sent it back to the Montgomery County Common Pleas Court. The decision, Tsonis v. Anesthesiology Servs. Network, Ltd., 2025-Ohio-5164 (2d Dist.), is a detailed lesson in how Ohio's medical-claim deadlines actually work.

What happened

According to the opinion, on July 20, 2021, Isidora Tsonis went to Miami Valley Hospital for an electrophysiology study, a heart procedure performed under general anesthesia. Her complaint alleges that the nurse anesthetist placed the breathing tube in her esophagus instead of her airway and did not recognize the error for 15 to 20 minutes, and that the supervising anesthesiologist failed to properly supervise. The procedure was cancelled. She became comatose, was put on a ventilator, and suffered a hypoxic brain injury.

She woke the next day and went home on July 23, but with memory problems. She has no memory of her hospitalization. She described her memories of the following weeks as "very jumbled, disjointed and difficult to keep straight," and said she did not begin to feel less disoriented until mid-August 2021.

The deadline fight

Ohio's basic rule for medical claims is short: suit must be filed within one year after the claim "accrues." R.C. 2305.113(A). A patient can extend that by sending a provider a written "180-day letter" before the year is up, giving notice of a possible claim; suit may then be filed within 180 days after the notice. R.C. 2305.113(B)(1). Since 2019, the statute has also specified how that letter must be sent: by certified mail, return receipt requested, to the provider's residence, practice, employer, or the business address on file with the licensing board. R.C. 2305.113(B)(2).

Her lawyer at the time mailed more than forty 180-day letters on July 2, 2022. Several were addressed to the anesthesia providers at the hospital's address. They were signed for on July 28, 2022. The trial court held that her claim accrued on her discharge date, July 23, 2021, so letters delivered on July 28, 2022 came too late. It granted summary judgment to the anesthesia providers, their practice group, and the hospital.

What the appeals court decided

The Second District, in an opinion by Judge Epley, reversed on three points.

1. Delivery, not proof the doctor saw it. The anesthesia providers argued the letters did not count because they never personally received them. The court disagreed. Because the 2019 amendment now spells out how the notice must be sent, the court held the notice is effective when it is delivered and properly receipted for by an appropriate person at an authorized address. Evidence indicated the providers' practice group had its offices at the hospital, and nothing showed the letters were delivered to the wrong place. Viewing the evidence in her favor, the letters were effective on July 28, 2022.

2. A brain injury can stop the clock. The court agreed that, viewed objectively, the event that should have put a patient on notice occurred on July 20, 2021, the day of the failed procedure. But Ohio law also pauses the deadline for a person who is "of unsound mind" when the claim accrues. R.C. 2305.16. Ms. Tsonis's records, her affidavit, and her husband's described serious cognitive problems after discharge. The court held there was a genuine factual question whether her brain injury delayed the start of the one-year clock until mid-August 2021. If it did, her letters were on time. That question has to be resolved with evidence, not on summary judgment.

3. A right to find out whether the providers left Ohio. Ohio law also pauses the one-year clock while a defendant is out of state. R.C. 2305.15(A). Under a 2000 Ohio Supreme Court decision the court discussed, that includes ordinary vacation travel. In this case, if either anesthesia provider spent as few as five days outside Ohio for personal reasons during the year, the claim against that provider would be timely. The trial court refused to let her take discovery on that question. The appeals court held that was an abuse of discretion, noting evidence that the defense had not cooperated in scheduling depositions and had sought to halt discovery while its motion was pending.

What the decision does not do

The appeals court did not decide that the nurse anesthetist, the anesthesiologist, or the hospital was negligent, and it did not finally decide that the case was filed on time. It reinstated the case so those questions can be decided on a full record. Ms. Tsonis still has to prove her claims.

One more caution. In October 2024, a new law, House Bill 179, took effect. As we explained in our post on H.B. 179, the out-of-state tolling rule no longer extends Ohio's four-year statute of repose for medical claims. It can still pause the one-year limitations period, which is how it was used here, but it will not rescue a claim filed more than four years after the malpractice.

The lessons for patients and families

The one-year clock is unforgiving, so start early. Every argument in this case was about days. Letters mailed on July 2 arrived on July 15, July 27, and July 28. Under Tsonis, a 180-day letter counts when it is delivered and signed for, not when it is mailed. Send it early, to every authorized address.

Know every way to protect a claim. The 180-day letter is one tool. Earlier this month we wrote about another: the Supreme Court's decision allowing patients who file on time to add providers within a 180-day window. The two cannot be stacked, so choosing between them is a strategic decision.

Document the injury's effect on the patient. In Tsonis, therapy notes, discharge records, and affidavits from the patient and her husband describing her memory problems created the factual dispute that saved the case. Families should keep a written record of a loved one's confusion, memory loss, and functioning after a hospital injury. Our guide chapter on preserving documents and records explains what to keep.

Anesthesia injuries are serious and often hidden. An airway error can cause permanent brain injury in minutes, and the patient is the one person who cannot tell you what happened. The records, the monitoring data, and the people in the room are the evidence. Our guide chapter on deadlines and the timeline of an Ohio injury case lays out the medical-claim clocks, and our personal injury page describes the serious-injury cases we handle.

What this means for you

If you or someone in your family suffered an injury during surgery or anesthesia, do not wait until the patient feels better to call a lawyer. The deadlines may already be running, and the notice letters, discovery, and medical evidence all take time to get right.