Full opinion text
AMENDED MEMORANDUM AND ORDER WEINSTEIN, Senior District Judge. Table of Contents I. FACTS. 537 A. Babb. 537 B. Cassell. 538 C. Colello-Moltzen. 538 D. Friedman. 589 E. Harnett. 539 F. Larson. 539 G. Minor . 540 H. White. 541 I. Zahn. 541 II. LAW APPLICABLE TO STATUTES OF LIMITATIONS-BASED CHALLENGES. 541 A. New York Statute of Limitations and Discovery Rule . 542 1. Statute. 542 2. Awareness that “injury” was due to human cause. 543 a. Language of the statute. 543 b. Precedents. 545 c. Comparison of sections 214-c(2) and 214-c(4). 546 d. Legislative design. 547 e. Policy. 551 f. Likely New York Court of Appeals’ construction . 553 B. Standard of Constructive Knowledge. 554 C. Two-Injury Rule. 555 D. Jury Resolution of Factual Disputes .-.. 556 E. Suits by Nonresidents. 557 1. Borrowing statute. 557 a. Applicability to section 214^c. 557 b. Date and place of accrual. 558 i. Place of encounter with harmful instrumentality. 559 ii. Place where injury is perceived . 559 iii. Place where viable cause of action becomes possible . 560 iv. Place of “last event”. 561 v. Place where injury was manifested . 562 vi. Possible applicability of “interest” analysis once New York is ruled out as accrual jurisdiction . 565 vii. Place most favorable to defendant. 566 c. Jury resolution of factual disputes. 566 2. Other states’ statutes of limitations. 566 a. Harnett. 567 b. Larson. 567 III. APPLICATION OF STATUTE OF LIMITATIONS LAW TO FACTS. 567 A. Babb. 567 .B. Cassell. 567 C. Colello-Moltzen. 568 D. Friedman. 568 E. Harnett. 568 F. Larson. 568 G. Zahn. 568 IV. SUBSTANTIVE CHALLENGES — HARNETT, MINOR AND WHITE. 569 V. CONCLUSION. 569 Defendants, formerly producers for use in pregnancy of diethylstilbestrol (DES), seek summary judgment against nine of nineteen plaintiffs in three separate actions. They assert statute of limitations defenses and the applicability, under choice-of-law principles, of substantive law that arguably precludes plaintiffs’ theories of liability. As indicated in the body of this memorandum, under New York law the statute of limitations is triggered when a plaintiff either discovered or reasonably should have discovered her “injury” from DES. Required is a showing not only that the plaintiff knew she was “ill,” but also that she was aware or should have been aware that her medical problem stemmed from “human” rather than “natural” causes. Because unresolved critical questions of fact require jury consideration in each of the cases, defendants’ motions are denied, except as noted below in the Minor, Harnett and White actions. I. FACTS DES is a synthetic drug that was prescribed between 1947 and 1971 to prevent miscarriages. The Food and Drug Administration banned this use of the drug in 1971 after studies indicated that in útero exposure to DES caused rare forms of vaginal and cervical cancer. See, e.g., Hymowitz v. Eli Lilly & Co., 78 N.Y.2d 487, 541 N.Y.S.2d 941, 539 N.E.2d 1069, cert. denied, 493 U.S. 944, 110 S.Ct. 350, 107 L.Ed.2d 338 (1989); Bichler v. Eli Lilly & Co., 55 N.Y.2d 571, 450 N.Y.S.2d 776, 436 N.E.2d 182 (1982); In re New York County DES Litig., 142 F.R.D. 58, 59 (E.D.N.Y.1992) (summary of cases); In re DES Cases (Ashley v. Abbott Lab.), 789 F.Supp. 552 (E.D.N.Y.1992) (jurisdiction). Plaintiffs claim that their various reproductive tract abnormalities and pregnancy-related difficulties, including infertility and miscarriages, were caused by DES exposure. Insofar as the relevant facts can be determined, they are as follows: A. Babb Tina Lee Babb’s complaint was filed on March 28,1995. Babb has been a New York resident her entire life. New York was the state of her mother’s residence during the pregnancy, the state in which the DES prescription was filled, the residence of the prescribing physician, the state where Babb was bom and apparently the state where her alleged medical problems were diagnosed. They include two miscarriages, an ovarian cyst, an abnormal pap smear and reproductive tract abnormalities. Babb consulted a “DES specialist” in 1983 or 1984 when she was 12, after her mother told her she was a DES daughter. A colpos-copy revealed an abnormal uterus in 1987 or 1988. Ovarian cysts were diagnosed in 1990. She experienced miscarriages in 1990 and 1998. She contends that she was not told that her miscarriages were caused by DES. The connection between her miscarriages and DES was learned, she claims, in 1995 from a newspaper article. B. Cassell Laura Cassell’s complaint was filed on March 28, 1995. Cassell has been a New York resident her entire life. New York was the state of her mother’s residence during the pregnancy, the state in which the DES prescription was filled, the residence of the prescribing physician, the state where Cas-sell was born and apparently the state where her alleged medical problems were diagnosed. They include an incompetent cervix, a T-shaped uterus, infertility and fear of DES-related cancer. Based upon a suggestion from her doctor during a 1985 consultation regarding her intention to conceive, Cassell asked her mother if she had taken any medication during pregnancy. Her mother responded that she had taken a drug to prevent miscarriages. Cas-sell's doctor concluded then that plaintiff had probably been exposed in útero to DES. Cassell was advised that she had an incompetent cervix in 1985. In 1986, she was diagnosed as having an infantile T-shaped uterus; she was also told in that year that she was at risk for DES-related cancer. In the late 1980s, she consulted with a fertility specialist and contacted a national fertility support group. In 1989, significant levels of antisperm antibodies were found, and a pelvic exam revealed various cervical abnormalities. Artificial insemination attempts in 1989 and 1990 were unsuccessful. A1992 laparos-copy confirmed cervical abnormalities. Cassell alleges that she did not connect her infertility to her DES exposure until January 1995, when she read a news article about DES. In an affidavit, she asserts that, while she was informed earlier that she might have trouble carrying a pregnancy to term, she was not told until March of 1993 that she might be infertile. C. Colello-Moltzen Eve Marie Colello-Moltzen’s complaint was filed on February 3, 1995. She is currently a California resident. Massachusetts was the state of her mother’s residence during the pregnancy, the state in which the DES prescription was filled and the residence of the prescribing physician. Colello-Moltzen’s family lived near the Rhode Island border, and she was born in a Rhode Island hospital. Based on the pleadings to date, it appears that Colello-Moltzen’s alleged medical problems were diagnosed in California. They include an incompetent cervix, vaginal and cervical adenosis, pregnancy requiring hospitalization, pregnancy requiring cerclage placement, a miscarriage, abnormal pap tests and emotional suffering. In 1977, Colello-Moltzen’s mother informed plaintiff of her DES exposure. During the course of a 1989 pregnancy, plaintiff consulted a doctor who, according to a medical record, informed her of potential pregnancy complications due to DES, including the possibility of an incompetent cervix. That pregnancy ended in a miscarriage. Although she experienced serious complications during her second pregnancy (1990) and third pregnancy (1994), both were successful. She had an abnormal pap smear in September 1990. Colello-Moltzen contends that her cause of action did not accrue until 1994 when, during a pregnancy, a doctor told her that she had an incompetent cervix caused by DES. In an affidavit submitted in opposition to defendant’s motion, she states that: 1) with respect to the causes of her first miscarriage, her doctor only informed her that “many women miscarry during their first pregnancy”; 2) her doctor informed her that stress was the cause of the preterm labor she expé-rieneed during her first successful pregnancy; 3) no doctor ever informed her, prior to the 1994 diagnosis, that'her DES exposure would prevent normal pregnancies. This affidavit appears to conflict in some respects with the notation about a doctor-patient discussion in her 1989 medical record noted above. D.Friedman Michele Friedman’s complaint was filed on March 28, 1995. She has been a New York resident since 1989, and also lived in New York from 1986 into 1987. New Jersey was the state of her mother’s residence during the pregnancy, the state in which the DES prescription was filled, the residence of the prescribing physician and the state where Friedman was born. New York was apparently the state where her alleged medical problems were diagnosed. They include infertility, three miscarriages and a T-shaped uterus. Friedman’s mother informed her of the DES exposure in 1981. Plaintiff underwent a hysterosalpinogram and a hysteroscopy in 1990. A medical report issued in connection with the hysterosalpinogram noted a T-shaped uterus that “is consistent with DES syndrome.” She reported during a 1991 Brooklyn Fertility Center consultation that she had experienced three miscarriages. She asserts that she asked her doctor in 1991 if her difficulty in conceiving was due to DES, but that he refused to express an opinion. On June 16, 1995, she underwent a hysterosalpinogram and a sonogram to determine the cause of her infertility. Friedman contends that she was unaware of the connection between her DES exposure and her medical problems until 1994, when she heard of a DES “class action” and underwent additional testing. In an affidavit submitted by the plaintiff, she contends that she was never informed that her miscarriage or infertility was related to her DES exposure, or that her T-shaped uterus would make it impossible for her to conceive. Since she believed that cancer was the only medical problem caused by DES, she states that she did not attribute her miscarriages and infertility to DES. E. Harnett Juli Ann Harnett’s complaint was filed on January 17, 1995. She is currently a resident of Florida, where she moved in 1990 from Colorado, her former residence. Colorado was the state of her mother’s residence during the pregnancy, the state in which the DES prescription was filled, the residence of the prescribing physician and the state where Harnett was born. She was either a resident of Colorado or Florida when her various alleged medical problems were diagnosed. They include a T-shaped uterus, an abnormal right fallopian tube, an irregular pattern on her uterine wall and infertility. Medical records demonstrate that Harnett knew of her DES exposure and was being medically monitored for potential complications in 1973. Records from the 1980s and into the 1990s document consultations with doctors over perceived problems with infertility. A 1989 hysterosalpinogram revealed a T-shaped uterus, irregular uterine walls and an abnormal right fallopian tube. Harnett underwent various fertility procedures in 1990. None were successful. Plaintiff and her husband subsequently adopted two children. Harnett contends that she learned “[s]ometime in 1992 ... that she [would] not be able to conceive due to her in útero DES exposure.” At the time of oral argument, plaintiff’s deposition had not been taken. Her attorney anticipated demonstrating that, notwithstanding plaintiffs medical records, Harnett was unaware of her medical problems until relatively recently. Harnett alleges, pursuant to an anticipated affidavit by the prescribing pharmacist, that Eli Lilly & Co. manufactured the DES ingested by her mother. F. Larson Katie King Larson’s complaint was filed on February 3, 1995. She has been a Texas resident since 1981; other relevant residences include Kentucky (1968-1971), California (1971-1972, 1974-1979) and Virginia (1972-1974). She also lists Mexico as a residence from 1976-1977. Alaska was the state of her mother’s residence during the pregnancy, the state in which the DES prescription was filled, the residence of the prescribing physician and the state where Larson was born. It is unclear from the record where each of her alleged medical problems were diagnosed. They include a T-shaped uterus, small uterine cavity, small os, vaginal adenosis, incompetent cervix, abnormal pap smears, infertility, endometriosis and mental distress. Larson was informed by her mother that she was a DES daughter in 1972 or 1973, and she was taken for a DES gynecological check-up at that time. Thereafter, she was monitored for possible medical problems related to her DES exposure. Medical records from the 1970s into the 1980s document ade-nosis, “vaginal changes” and dysplasia. These diagnoses required various medical interventions, including cryosurgery and laser vaporization of the ectocervix. Her deposition confirms that during this time she was aware of some of the potential problems she faced due to her DES exposure — especially cancer. Larson consulted a doctor in 1987 in connection with her decision to try to become pregnant. Proactively, and at her sister’s suggestion, she requested a hysterosalpino-gram to try to determine whether she could carry a pregnancy to term. A 1988 hystero-salpinogram revealed a small T-shaped uterus. Medical records indicate that her doctor informed her that she might have difficulty becoming pregnant and that she risked preterm labor. In 1989, Larson consulted with a doctor about her inability to become pregnant. Fertility treatments were suggested. She returned to her doctor’s office in 1990, still complaining of difficulties in becoming pregnant. Various fertility treatments, including five artificial inseminations, were attempted prior to August 1991. At her deposition, she asserted that she was “probably” informed of her incompetent cervix prior to 1991. Plaintiff attended an adoption seminar in April 1992, and was approved for adoption in March of 1993. A letter dated May 21,1992, that she obtained from her doctor in connection with her intention to adopt, states “Ms. King was exposed to DES as an embryo, and has an abnormal HSG as a result”; notes “an ovulation disorder” which has not responded to medication; and identifies “adoption” as her “best option.” Plaintiff adopted a child in 1993. She has never been pregnant although she stopped using birth control many years ago. On February 6,1995, plaintiff underwent a laparoscopy that revealed endometriosis. Defendants note that a laparoscopy examination was recommended by two of her doctors in 1991, but that she did not undergo the procedure until 1995. Surgery was performed to remove the visible endometriosis. Larson contends in an affidavit that she was never told, in connection with her medical problems, that she was sterile or would be unable to bear a child. She asserts that cancer was the only potential manifestation about which she was concerned when she initiated medical consultations in relation to her DES exposure. She testified during her deposition that a fertility specialist informed her, during a fertility consultation on or after August 1991, when she began seeing the specialist, that her DES exposure “was not an issue” — that “there [were] still things that I could attempt in order to get pregnant.” She points to other potential sources of her difficulties in becoming pregnant — her husband’s possible impotence, their difficulty finding time together — that she asserts made a conclusion about her own infertility premature. Plaintiff states that she is still unsure if she is infertile. She is still attempting to conceive. She contends that she was not aware of defendants’ liability until she learned, through the media, about a lawsuit filed in New York in 1994. G. Minor Lori Beth Minor’s complaint was filed on February 3, 1995. She is currently an Iowa resident. Iowa was the state of her mother’s residence during the pregnancy, the state in which the DES prescription was filled, the residence of the prescribing physician, the state where Minor was born and apparently the state where her alleged medical problems were diagnosed. They include a small T-shaped and hypoplastic uterus, a hooded cervix, abnormal pap smears, fear of cancer and infertility. Defendants’ motion with respect to Minor rests solely on Iowa’s substantive law, which requires identification of the specific manufacturer of the DES to which a plaintiff was exposed. In response to defendants’ “Preliminary Request for Information,” Minor asserted that Eh Lilly & Co. manufactured the DES ingested by her mother. Her assertion is supported by an affidavit by the owner of the prescribing pharmacy which states that “Lilly brand of DES” was the only brand carried by the pharmacy from 1960 to 1970, encompassing the period of plaintiffs exposure. She was born in 1963. H. White Paige White’s complaint was filed on March 28, 1995. White is currently a resident of the state of Kentucky, where she has lived for the past 21 years, and where her alleged medical problems were diagnosed. Georgia was the state of her mother’s residence during the pregnancy, the state in which the DES prescription was filled, the residence of the prescribing physician and the state where White was born. Her alleged medical problems include a stenotic cervix and a small uterine cavity. Defendants’ motion with respect to White rests solely on Georgia’s substantive law. Georgia has not recognized market share liability. In opposition to defendants’ motion, White has submitted an affidavit which states “[m]y mother told me that she recalls [that] the brand of DES that she took during her pregnancy with me was Eli Lilly.” I. Zahn Kerry Ellen Zahn’s complaint was filed on February 3, 1995. Plaintiff has been a resident of either Virginia (August 1988-August 1990 and August 1993-present) or Massachusetts (1964-August 1988 and August 1990-August 1993) since birth. Massachusetts was the state of her mother’s residence during the pregnancy, the state in which the DES prescription was filled, the residence of the prescribing physician and the state where Zahn was bom. Some of plaintiffs alleged medical problems were apparently diagnosed while she was a Massachusetts resident and others while she was a Virginia resident. They include a T-shaped uterus, other uterine abnormalities, a cockscomb cervix, abnormal fallopian tubes, adenosis and infertility. Zahn was informed when she was 14 that her mother had ingested DES. She was tested at a DES clinic for cervical and vaginal cancer at that age. She consulted two doctors about some difficulties with conception in 1990 and 1991. She was diagnosed at the end of 1991 as having a blocked right fallopian tube, a small uterus, a short cervix and a small cervical opening. A hysterosco-py revealed a uterine ridge. In deposition testimony, she stated that she was informed by her doctor in October of 1991 that she would not be able to become pregnant without in vitro fertilization. She also stated that she told her doctor, in late 1990 or early 1991, that “I was DES exposed, that I wasn’t pregnant and what was I going to do about it.” By January 1992, she began the process for in vitro fertilization. Zahn contends that not until a 1993 hyster-osalpinogram did she learn that she has an infantile T-shaped uterus and that it was due to DES exposure. At that time, she asserts, her doctor informed her that a miscarriage and her difficulty in conceiving could be attributed to abnormalities in the size and shape of her uterus. Defendants counter that none of her records submitted to date indicate the presence of a T-shaped uterus. Defendants also point to a radiology report prepared in connection with the 1991 hyster-osalpinogram that characterized plaintiffs uterus as having a “normal appearance.” II. LAW APPLICABLE TO STATUTES OF LIMITATIONS-BASED CHALLENGES Defendants assert that claims made by Babb, Cassell, Colello-Moltzen, Friedman, Harnett, Larson and Zahn are time-barred under the applicable statutes of limitations. Federal courts sitting in diversity apply the substantive law of the forum state on outcome-determinative issues, Erie R.R. v. Tompkins, 304 U.S. 64, 80, 58 S.Ct. 817, 823, 82 L.Ed. 1188 (1938); 28 U.S.C. § 1652 (1988), including the forum state’s approach to choice-of-law problems, Klaxon Co. v. Stentor Elec. Mfg. Co., 313 U.S. 487, 496, 61 S.Ct. 1020, 1021-22, 85 L.Ed. 1477 (1941), and the forum state’s applicable statute of limitations, see Guaranty Trust Co. v. York, 326 U.S. 99, 109-11, 65 S.Ct. 1464, 1470, 89 L.Ed. 2079 (1945), together with the state’s borrowing statute. See Block v. First Blood Assocs., 988 F.2d 344, 349 (2d Cir.1993). In determining the applicable state law, greatest weight is given to. decisions of the forum state’s highest court, in this case the New York Court of Appeals, the state’s constitution and its statutes. Erie, 304 U.S. at 78, 58 S.Ct. at 822; Travelers Ins. Co. v. 633 Third Assocs., 14 F.3d 114, 119 (2d Cir.1994). Where an issue has not been decided definitively, the district court must predict how the highest state court would resolve the legal issue. DeWeerth v. Baldinger, 38 F.3d 1266, 1273 (2d Cir.1994); Travelers Ins. Co., 14 F.3d at 119; In re E. & S. Dist. Asbestos Litig., 772 F.Supp. 1380, 1388-91 (E. & S.D.N.Y.1991), rev’d in part on other grounds sub nom., In re Brooklyn Navy Yard Asbestos Litig. (Joint E. & S. Dist. Asbestos Litig.), 971 F.2d 831 (2d Cir.1992). “[G]reat weight” is given to “lower state court decisions,” with decisions of “intermediate state appellate courts ... particularly persuasive.” In re E. & S. Dist. Asbestos Litig., 772 F.Supp. at 1390. Nevertheless, federal district courts are not bound by lower state court precedents that they find probably would be rejected on appeal. Commissioner v. Estate of Bosch, 387 U.S. 456, 465, 87 S.Ct. 1776, 1782-83, 18 L.Ed.2d 886 (1967); In re E. & S. Disk Asbestos Litig., 772 F.Supp. at 1390. A. New York Statute of Limitations and Discovery Rule 1. Statute New York’s general limitations period for personal injuries is three years. N.Y.Civ. Prac.L. & R. § 214(5). Prior to 1986, the limitations period for harm caused by exposure to a toxic substance ran from the date of last exposure to the substance. See Enright v. Eli Lilly & Co., 77 N.Y.2d 377, 383, 568 N.Y.S.2d 550, 553, 570 N.E.2d 198, 201, recons. denied, 77 N.Y.2d 990, 571 N.Y.S.2d 916, 575 N.E.2d 402, cert. denied, 502 U.S. 868, 112 S.Ct. 197, 116 L.Ed.2d 157 (1991); Glod v. Morrill Press Div. of Engraph, Inc., 168 A.D.2d 954, 564 N.Y.S.2d 905, 907 (App. Div. 4th Dep’t 1990). But see Snyder v. Town Insulation, Inc., 81 N.Y.2d 429, 599 N.Y.S.2d 515, 615 N.E.2d 999 (1993). In 1986, as part of a general “tort reform” package, the New York State legislature adopted a “discovery” rule for torts involving substances with latent effects. N.Y.Civ.Prac.L. & R. § 214-c. Under the new statute, the three-year limitations period runs from the time that the plaintiff discovered, or should have discovered, her “injury”: [T]he three year period within which an action to recover damages for personal injury or injury to property caused by the latent effects of exposure to any substance or combination of substances, in any form, upon or within the body ... must be commenced shall be computed from the date of discovery of the injury by the plaintiff or from the date when through the exercise of reasonable diligence such injury should have been discovered by the plaintiff, whichever is earlier. Id. § 214-c(2) (emphasis added). As noted below, section 214-c(4) deals with the situation where scientific knowledge has not revealed which substance or substances might have caused the claimant’s symptoms. Claims based on torts committed before July 1, 1986, in which the “injury” was discovered or should have been discovered prior to that date, are time-barred if they were time-barred prior to July 1, 1986 and were not brought during a one-year window provided by the legislature. Id. § 214-c(6); L.1986, c. 682. Another New York provision addresses the situation in which the plaintiff became aware of an “injury,” but the state of scientific and medical knowledge initially prevented her from ascertaining its cause. Such a plaintiff may file a claim within one year of discovering the cause, provided that discovery of the cause occurred within five years of actual or constructive discovery of the “injury” itself. The provision, New York Civil Practice Law and Rules section 214-c(4), states: [Wjhere discovery of the cause of the injury is alleged to have occurred less than five years after discovery of the injury or when with reasonable diligence such injury should have been discovered, whichever is earlier, an action may be commenced or a claim filed within one year of such discovery of the cause of the injury; provided, however, if any such action is commenced or claim filed after the period in which it would otherwise have been authorized pursuant to [section 214-c(2) ] the plaintiff or claimant shall be required to allege and prove that technical, scientific or medical knowledge sufficient to ascertain the cause of his injury had not been discovered, identified or determined prior to expiration of the period within which the action or claim would have been authorized and that he has otherwise satisfied the requirements of [section 214-c(2)]. 2. Awareness that “injury” was due to human cause a. Language of the statute As developed more fully in Parts II. A.2.b-f, infra, sections 214-c(2) and 214-c(4) must be interpreted in the DES context to provide that discovery of the “injury” includes awareness not only of a medical problem, but that the difficulty resulted from a human rather than a natural cause. This result is required by the statute’s use of the words “cause” and “injury” rather than “disease,” or a synonym for that kind of etiology; the design and pattern of the statute; and the particular nature of latent injuries and toxic torts, as well as of scientific knowledge, that required section 214-c’s adoption. The legislative history of section 214-c and the courts’ interpretation of the provision have been ambiguous, a matter discussed in Part II.A.2.b-d, infra. First, however, it is necessary to turn to the language of the provisions. What must be “discover[ed]” under section 214-c(2) is “injury ... caused by ... exposure to any substance.” The three operative words in the instant eases are “injury,” “cause” and “substance.” Read independently and together, they imply a human intervention that resulted in the medical difficulties alleged by these plaintiffs. The sensible interpretation of the word “cause” here implies a human intervention. For example, the definition of “cause” in Webster’s New Twentieth Century Dictionary, Unabridged (2d ed. 1979) reads in whole: cause, n. [ME. cause; OFr. cause; L. causa, a cause, reason.] 1. a suit or action in court; any legal process which a party institutes to obtain his demand, or by which he seeks to realize his claim, lawsuit, case. The cause of both parties shall come before the judges.—Ex. xxii. 9. 2. that which produces an effect or result; that from which anything proceeds, and without which it would not exist. Cause is a substance exerting its power into act, to make a thing begin to be.—Locke. 3. a person or thing acting voluntarily or involuntarily as the agent that brings about an effect or result; as, a woman was the cause of his downfall. 4. a reason, motive, or ground for producing or trying to produce a given effect; as, cause for joy; cause for anger. 5. reason enough; as, cause for divorce. 6. any activity or movement that a number of people are interested in and support; as, slum clearance is a good cause. 7. any matter as a subject of discussion. efficient cause; the power or agent that effects a result. final cause; the purpose or end for which anything is produced. formal cause; the ideal form according to which any thing or event is produced or brought about, as the form of a painting in the mind of any artist. material cause; the means employed to produce a formal cause, as the oils, water colors, etc. used in a painting. to make common cause with; to work together with toward the same objective; to form an alliance with. Syn.—incitement, inducement, motive, origin, reason, source, purpose, object. While the word “cause” standing alone may imply either a human or non-human antecedent, here, in a provision dealing with suits by persons against other persons, non-human agents are excluded from the meaning. It is the second and third of these definitions that are apropos. Note particularly Locke’s combining of cause and substance “exerting its power ... to make a thing begin to be.” “Injury” also implies a human act rather than a natural progression. The definition reads in'ju ry, n.; pi. in'ju- ries, [ME. injurie; OFr. injure; L. injuria, wrong, an injury, an unjust act, from injwriosus, acting unjustly; in —priv., and jus, juris, right, justice.] 1. physical harm or damage to a person, property, etc. 2. unjust treatment; violation of rights; offense. 3. an injurious act. 4. insult. [Obs.] Syn.—damage, hurt, harm, mischief, detriment, wrong, impairment.—Damage is that injury to a thing which occasions loss to a person or a diminution of value to a thing; hurt implies a wound inflicted physically or emotionally that destroys the soundness or integrity of things; harm suggests the causing of pain or distress; mischief suggests a troublesome injury, that may simply produce inconvenience or annoyance. Id. Substance, in this context, implies a human-made product rather than a naturally occurring defect or pathogen, substance, n. [L. substantia, essence, material, from substare, to be present, exist.] 1. the real or essential part or element of anything; essence; reality; matter. 2. the physical matter of which a thing consists; material. 3. (a) solid quality; substantial character; (b) consistency; body. 4. the real content of a statement, speech, etc.; true meaning; purport. 5. matter of a particular kind; stuff. 6. material possessions; property; resources; wealth. 7. in philosophy, the essence or substratum which underlies and is capable of having attributes or causing phenomena, but which in spite of changes in outward manifestation remains the same; that which really is or exists, as distinguished from its qualities, attributes, and the phenomena by which it is perceived. 8. in theology, the divine essence or personality, as considered common to each member of the Trinity. The Son is said to be the same substance as the Father—that is, truly and essentially God as the Father is.—Eden. in substance; (a) with regard to essential elements; substantially; (b) actually, really. Id. (emphasis added). This natural reading of the language used in the statute suggests that the drafters had in mind “discovery” of the fact that it was a toxic substance that led to the plaintiffs medical problem. The “injury” to plaintiff must be “caused” by a “substance” wrongfully produced by a prospective defendant or there can be, in the words of the statute, no “action to recover damages.” That the defect in plaintiffs body was so caused by a prospective defendant is the raison d’étre of the statute. As developed in more detail below, if a person has a medical problem, unless she has good reason to conclude that, contrary to the usual course of events, a human-made product led to the difficulty, she has not “discovered” that it was “caused.” The few precedents, none of which are from the New York Court of Appeals, must be examined in light of this fundamental sense of section 214-c in DES cases. b. Precedents “Discovery” of an “injury” under section 214-c(2) does not necessarily occur at the “ ‘first onset of symptoms.’ ” Michael v. Ametelco, Inc., 150 Misc.2d 507, 568 N.Y.S.2d 1008, 1005 (Sup.Ct. Monroe County), aff'd sub nom., Michael v. Eastern Alloys, Inc., 175 A.D.2d 667, 573 N.Y.S.2d 945 (App.Div. 4th Dep’t), appeal denied, 78 N.Y.2d 862, 578 N.Y.S.2d 877, 586 N.E.2d 60 (1991). “Injury” does not include “any symptom however trivial.” See Griffin v. Garratt-Callahan Co., No. CV-94-0395, 1995 WL 151824, at *3 (E.D.N.Y.1995); see also Mesa v. United Nations Dev’t Corp., 157 Misc.2d 362, 596 N.Y.S.2d 1012, 1014 (Sup.Ct.N.Y.County 1993). One court explained that “‘injury’ ... refer[s] to an actual illness, physical condition or other similarly discoverable manifestation of the damage caused by previous exposure to an injurious substance.” Sweeney v. General Printing Co., 210 A.D.2d 865, 621 N.Y.S.2d 132, 133 (App.Div. 3d Dep’t 1994). Although the New York Court of Appeals has not ruled on the issue, a number of federal and lower state cases have opined that, under section 214-c(2), a plaintiff need not be aware of the “cause” of her symptoms to be held to have “discovered” her “injury.” See, e.g., Sweeney, 621 N.Y.S.2d at 133; Johnson v. Ashland Oil, Inc., 195 A.D.2d 980, 601 N.Y.S.2d 756, 757 (App.Div. 4th Dep’t 1993); Michael 568 N.Y.S.2d at 1007; Wallen v. American Telephone & Telegraph Co., Index No. 12336/91 (N.Y.Sup.Ct.Bronx County Sept. 17, 1992), aff'd, 195 A.D.2d 417, 601 N.Y.S.2d 796 (1st Dep’t), appeal denied, 82 N.Y.2d 659, 605 N.Y.S.2d 5, 625 N.E.2d 590 (1993); Griffin, 1995 WL 151824, at *3 (citing Sweeney and Johnson); Adams v. Key Tronic Corp., No. 94-CV-0535 (MEL), 1994 WL 594779, at *1 (S.D.N.Y. Oct. 31, 1994) (citing Wallen). These restrictive precedents have been relied upon by the Supreme Court, New York County, in dismissing DES claims on statute of limitations grounds. See, e.g., Culpepper v. Eli Lilly & Co., Index No. 115878/93, slip op. at 2 (N.Y.Sup.Ct. N.Y.County Mar. 14, 1995) (unpublished); Wetherill v. Eli Lilly & Co., Index. No. 22566/92, slip op. at 3-8 (N.Y.Sup.Ct. N.Y.County Oct. 12, 1994) (unpublished); Indovino v. Abbott Lab., Index No. 21581/91, slip op. at 4 (N.Y.Sup.Ct. N.Y.County Aug. 11, 1993) (unpublished); Horton v. Eli Lilly & Co., Index. No. 26321/92, slip. op. at 4-5 (N.Y.Sup.Ct. N.Y.County July 29, 1993) (unpublished). As demonstrated below, it is unlikely that the New York Court of Appeals will adopt this narrow view of applicable law to bar otherwise valid DES claims. Independent of, and separate from, a plaintiffs awareness of the fact that she is medically impaired must be her awareness that her medical problem was “caused” by something extrinsic to her biology — that someone has done something to her. A plaintiff may only discover aspects of her claim in pieces: (1) the fact that she has a medical problem; (2) the fact that the problem has a human cause; (3) the nature of the injurious agent (e.g., drug, gas, etc.); (4) the specific identity of the injurious agent (e.g., DES, asbestos); and (5) the fact that someone or some entity was liable, in some way, in connection with marketing, producing or distributing the causative agent. The instant cases require that the plaintiffs be aware of (1) and (2) at minimum. It is not necessary to address the need for knowledge of (3), (4) and (5) under the statute in the context of these particular DES cases since in each case knowledge of (1) and (2) would almost certainly have led directly to knowledge of (3), (4) and (5). Since each plaintiff knew she was a DES daughter, once she knew her medical problem was caused by human intervention in the form of a manufae-tured product she should have realized DES and its manufacturers were responsible. Published precedents have not considered this hierarchy of discovery in construing section 214-c. Except for one unpublished opinion, the cases have not addressed the dichotomy of human versus natural causative agents critical to the instant litigations. The one unpublished opinion of which the court is aware is that of a highly respected New York trial court, Horton v. Eli Lilly & Co., supra. It rejected in dictum “plaintiff’s argument that some factual knowledge of wrongdoing by a third party is necessary to start the running of [N.Y.Civ.Prac.L. & R. § 214-c].” Id, slip op. at 6. In a DES case, New York policy requires that section 214-c(2) be construed as triggering the statute of limitations, at the earliest, on a plaintiffs reasonable discovery of 1) her medical problem and 2) the fact of its human causes. Discovery under the statute occurs at the point in time that a plaintiff becomes aware, or should have become aware, that her disease or other medical problem was caused by something extrinsic to her biological system — i.e., that it did not just “happen.” The basis for this conclusion is discussed in Part II.A.2.e, infra. What follows, first, is a discussion of the basis for the few court interpretations of the New York statute. These interpretations are overly restrictive. The wording of the statute, and the legislative design, do not foreclose sensible construction of “discovery of injury” to require a plaintiffs awareness of both her medical problem and its human cause. c. Comparison of sections 214-c(2) and 214-c(4) The restrictive construction adopted in non-New York Court of Appeals decisions is based upon a comparison of section 214-c(2) and section 214-c(4). For reasons explained below, that comparison is not persuasive on the issue of whether “discovery” of an “injury” should be construed to require discovery of some aspect of the injury’s “cause.” According to these restrictive decisions, section 214^-c(4) exists to prevent an otherwise harsh result where the cause of the plaintiffs medical problem was temporarily unknowable due to the state of scientific knowledge at the time the problem was discovered. Reading section 214-c(2)’s reference to “discovery of injury” to mean “discovery of the cause of the injury,” they suggest, would render section 214-c(4) redundant. To prevent the apparent redundancy, a few New York cases have held, in effect, that section 214r-c(4) creates a narrow exception to the general rule in section 214^e(2) that knowledge of any aspect of cause is not required for the statute of limitations to begin to run. See Michael, 568 N.Y.S.2d at 1007 (“If the term injury encompassed causation, that is, if injury were to be defined as an illness or disease believed or suspected to be caused by toxic substance exposure, ... the limitations provisions of subdivision 4 would not be necessary”); see also Sweeney, 621 N.Y.S.2d at 133 (construction of 214-c(2) and 214-c(4)); Johnson, 601 N.Y.S.2d at 757 (same). In fact, construing “discovery of injury” in section 214-c(2) to require plaintiffs awareness of both her medical problem and its cause would not render section 214-c(4) redundant. Both provisions are needed to ensure full recovery in the not uncommon situation where a plaintiffs medical problems are caused by synergistic or confounding effects of two or more substances. Due to the then-existing state of scientific knowledge, a plaintiff may only have been aware of one of several substances that “caused” her medical problems at the time that she first filed a suit timely under section 214-c(2). As scientific knowledge evolves, section 21-^c(4) ensures that a plaintiff who later discovers — through new scientific information — that other defendants’ delicts or substances are implicated will not unreasonably be denied recovery on the ground that an action against the newly discovered defendants is barred by 214-c(2). It is typical in medical problems associated with exposure to toxic substances for scientists to establish over time the presence of several substances or agents acting in combination. See, e.g., Cantrell v. GAF Corp., 999 F.2d 1007, 1013 (6th Cir.1993) (synergy between smoking and asbestos in causing plaintiffs’ medical problems); Ingram v. Acands, Inc., 977 F.2d 1332, 1342 (9th Cir.1992) (similar); J. Morelli & Orna Harish, Establishing Causation in Contamination Cases, N.Y.L.J., June 12, 1995, at S4 (need for experts in “medico-legal” cases to consider synergies implicated in plaintiffs’ medical problems); cf. Citizens for a Better Env’t v. Reilly, No. 85 C 8000, 1991 WL 95040 (N.D.Ill. May 24, 1991) (practical difficulties of testing synergistic effects of chemical substances). The statute, by its terms, recognizes the potential synergism in medical problems due to toxic exposure. Section 214-c(2) is explicitly worded to govern “an action to recover damages for personal injury ... caused by the latent effects of exposure to any substance or combination of substances, in any form, upon or within the body.” N.Y.Civ.Prac.L. & R. § 214-c(2) (emphasis added). Without section 214-c(4) a plaintiff could be barred from suing under 214-c(2) before new scientific data implicating other substances had even been developed. The whole picture of a class of injuries may emerge only gradually, as more and more information about individual cases — the length and the duration of the exposure, the context of the exposure, the presence of confounding environmental factors, and the like — is collected and processed. Scientific discovery tends to be incremental; instantaneous global comprehensive solutions are rare. Cf. Phyllida Brown & David Concar, HIV Epidemic Threatens Asia’s Developing Nations, New Scientist, June 22, 1991, at 18 (“ ‘Science does not work in breakthroughs. It works in small, incremental steps.’ ” (quoting Anthony Fauci, Director, U.S. Nat’l Inst, for Allergy and Infectious Disease)). Scientific information required to evaluate the basis of a claim may not be always available at the time that it is needed, or in the form that is desired. See The Lesson of Mass Tort Litigation in the United States: The Need for Consistency and Cooperation in the Utilization of Scientific Evidence by the Courts, F.U.S.-E.C. Leg.-Econ.Aff. 13-18 (Mentor Group, Boston, 1995) (on file in these eases). For example, even in the asbestos cases, where the scientific bases of asbestos-caused lung diseases have been long known, see In re Joint E. & S. Dist. Asbestos Litig. (Findley v. Blinken), 129 B.R. 710, 734-51 (E. & S.D.N.Y.1991), vacated on other grounds, 982 F.2d 721 (2d Cir.1992), modified on reh’g, 993 F.2d 7 (2d Cir.1993), scientific information is still being developed on whether colon cancer can be or is caused by exposure to asbestos. See In re Joint E. & S. Dist. Asbestos Litig., 52 F.3d 1124 (2d Cir.1995). The two provisions in section 214-c must be read as an intelligent and thoughtful accommodation to the nature of many plaintiffs’ injuries — particularly the potential for multiple causes — and to the incremental nature of scientific discovery. Under this sensible reading, it is assumed that a plaintiff who discovers her “injury” and its cause, to the extent possible given the then-current state of scientific knowledge, will file suit in a timely fashion as provided by section 214-c(2). If she later discovers additional causes that were scientifically unknowable to her at the time she first filed suit, she may proceed under section 214-c(4), provided that provision’s other requirements are met. Without section 214-c(4), the words “combination of substances” in section 214-c(2) could bar, on statute of limitations grounds, suits against those responsible for the newly identified causative agent or agents. Section 244-c(4) is a compromise approach, rather than a guarantee of full recovery. While that provision provides for suits filed within a year of plaintiffs’ discovery of previously scientifically unknowable causes, it also mandates that such suits be filed within five years of discovery of the “injury.” It must be assumed that “discovery of the injury” under section 214-c(4) means the same thing as “discovery of the injury” under section 214-c(2). d. Legislative design The legislative record is inconclusive on the issue of whether “discovery” was intended to encompass merely knowledge of the medical problem, or knowledge of the medical problem together with its cause. One source of information is the text of the bills that preceded the final, enacted, version. Another basis for interpretation is the discussion of the final version of the bills in the State Senate and Assembly that preceded enactment. The different approaches adopted in Senate and Assembly versions of the bills that preceded enactment of the discovery rule do not establish that the legislature considered and rejected knowledge of the “injury’s” cause, even in its broadest sense, as a component of “discovery” under section 214-c(2). See generally Steven L. White, Note, Toward a Time-of-Discovery Rule for the Statute of Limitations in Latent Injury Cases in New York State, 9 Fordham Urban L.J. 113, 154-57 (1985). On March 12, 1984, the Assembly passed a bill, A. 3547-A, which would have explicitly provided for accrual on plaintiff’s discovery of her “disability” and its “cause[ ]” by exposure to a toxic substance: [Wjhere the injury or illness is damage to the respiratory system or other system, part or function of the body caused by exposure to a substance, material, element or particle, the effects of such exposure being latent and not manifested upon exposure, the time for commencement of an action or proceeding to recover damages for such injury or illness shall be the latter of the following: 1. within two years after the date the plaintiff first suffered disability; or 2. within two years after the date the plaintiff discovered that such disability was caused or contributed to by such exposure. See White, supra, at 154-55 & n. 262 (emphasis added). A different version of a time-of-diseovery bill, S. 9158, drafted by Senator Ronald B. Stafford and considered in a Senate committee in May of 1984 did not explicitly require plaintiffs’ knowledge of the causes of their medical problems for the statute of limitations to run; in addition, it added a “reasonable diligence” standard: [A]n action to recover damages for personal injury or injury to property caused by the latent effects of exposure to a toxic or harmful substance may be commenced within two years from the date of discovery of the injury or within two years from the date when through the exercise of reasonable diligence such injury should have been discovered, whichever is earlier. See White, supra, at 156 & n. 267. The differences between these two precursors to section 214r-c, and the apparent dominance of S. 9158 in the final, enacted product, while arguably supportive of a restrictive interpretation, does not negate the natural reading of the language of the statute. The drafters could well have concluded that the language, “plaintiff discovered that such disability was caused or contributed to by such exposure,” was unnecessary — that the concept “discovery,” in context, included plaintiffs awareness of her “injury” and its cause by the latent effects of toxic substances. Such a natural reading would have made the Assembly’s language redundant and unnecessary. Discussions of the final version of the “discovery rule” in the legislature that preceded its enactment suggest that the statute’s drafters were concerned that New York was out of the mainstream in its handling of medical problems caused by the latent effects of harmful products, and sought to bring New York into line with other jurisdictions. See New York State Assembly Debate Transcript, Bill No. 10,664, June 24, 1986, at 60-93 (N.Y.Legis.Serv.); New York State Senate Debate Transcript, Chapter 682, at 5145-54 (N.Y.Legis.Serv.). In his concluding remarks in support of adoption of the discovery provision, Senator Stafford (who, as noted above, was responsible for the less explicit Senate version ultimately adopted) emphasized the need to bring New York State into the mainstream: “And, finally,” he pointed out, “over 40 states have this legislation, and we feel that New York should be one of them.” See Senate Transcript, supra, at 5151. In a memorandum approving the bill, the Governor echoed the legislature’s expectation that the discovery provision would bring New York into the mainstream: This bill ... repeals th[e] anarchic rule[, under which suit had to commence within three years of exposure to the substance,] and replaces it with a fair and simple rule which permits a person to discover his or her injury before the statutory time period for suit begins to run. In enacting this law, New York joins more than 10 other states which have legislatively or judicially created a statute of limitations discovery rule. Governor’s Memorandum filed with Senate Bill Number 9391-A (July 30, 1986), in Governor’s Bill Jacket, Chapter 682, 1986 (N.Y.Legis.Serv.) (emphasis added). In contrast, the construction advanced by defendants would make New York’s discovery rule the most restrictive in the nation. As described by the federal district court for the District of Columbia, a generic discovery rule requires actual or constructive knowledge of both the “injury” and its cause; the role of wrongdoing in bringing about the “injury” is implied in the term “cause.” In general, discovery rules are adopted to avoid the unfairness of interpreting a statute of limitations to accrue when the injury first occurs, if at that time plaintiff does not have enough information to bring suit. This policy is applied to different factual situations as they arise. Where the injury is latent, the claim is held not to accrue until the plaintiff discovers the injury. Where causation of an injury is unknown, the action accrues when both the injury and its cause have been (or should have been) discovered. Where the injury and causation are known, but not that there has been any wrongdoing, the action is held to accrue when the plaintiff discovered, or by due diligence should have discovered, the wrongdoing.... While a few courts have forthrightly rejected some or all of these interpretations, most have at least phrased their discovery rules in a manner that could allow such interpretations should an appropriate ease arise. Dawson v. Eli Lilly & Co., 543 F.Supp. 1330, 1338 (D.D.C.1982). See also, e.g., Jolly v. Eli Lilly & Co., 44 Cal.3d 1103, 1112, 751 P.2d 923, 928, 245 Cal.Rptr. 658, 663 (1988) (DES case; limitations period triggered when plaintiff knows of her injury, its cause, and has a “suspicion of wrongdoing”); In re Asbestos Litig. West Trial Group, 622 A.2d 1090, 1093 (Del.Super.Ct.New Castle County 1992) (asbestos case; “Under the discovery rule, the statute of limitations does not begin to run until the plaintiff is chargeable with the cause of her injury.”); Dawson, 543 F.Supp. at 1338 (DES case; applying District of Columbia law to hold that the limitations period is triggered when plaintiff is aware of her injury, its cause, and the presence of wrongdoing), cited with approval in, Bussineau v. President & Directors of Georgetown College, 518 A.2d 423, 425 (D.C.1986), reh’g denied, 525 A.2d 595 (D.C.), recons. denied, 532 A.2d 89 (D.C.1987); Colon v. Celotex Corp., 465 So.2d 1332, 1334 (Fla.Dist.Ct.App.1985) (asbestos case; limitations period triggered when plaintiff “knew or should have known ... that he had a cause of action against the defendants”), quashed on other grounds, Celotex Corp. v. Meehan, 523 So.2d 141 (Fla.1988); Anderson v. Sybron Corp., 165 Ga.App. 566, 567, 353 S.E.2d 816, 817 (Ct.App.) (cataracts caused by exposure to ethylene oxide; limitations period triggered when plaintiff “knew or through the exercise of reasonable diligence should have discpver-ed not only the nature of his injury but also the causal connection between the injury and the alleged negligent conduct of [the defendant]”), aff'd, 251 Ga. 593, 310 S.E.2d 232 (1983); Nolan v. Johns-Manville Asbestos, 85 Ill.2d 161, 421 N.E.2d 864, 868-69, 52 Ill.Dec. 1, 5-6 (1981) (asbestos case; limitations period triggered when plaintiff learns of injury and fact that it was “probably” caused by someone else’s wrongdoing); Louisville Trust Co. v. Johns-Manville Prods. Corp., 580 S.W.2d 497, 501 (Ky.1979) (asbestos case; limitations period triggered when plaintiff learns of injury and fact that it was caused by defendant’s conduct); Bowen v. Eli Lilly & Co., 408 Mass. 204, 207, 557 N.E.2d 739, 742 (1990) (DES case; “[P]laintiff [must] have (1) knowledge or sufficient notice that she was harmed and (2) knowledge or sufficient notice of what the cause of her harm was.”); Moll v. Abbott Lab., 444 Mich. 1, 23-24, 506 N.W.2d 816, 827-28 (1993) (DES case; limitations period is triggered when plaintiff is aware of her injury and its “possible” cause); Elmore v. Owens-Illinois, Inc., 673 S.W.2d 434, 436 (Mo.1984) (en banc) (asbestos case; cause of action for asbestosis accrued when, on diagnosis, plaintiff became aware of both the “character of the condition (asbestosis) and its cause (breathing asbestos dust)”); Sawtell v. E.I. Du Pont De Nemours & Co., 22 F.3d 248, 252 (10th Cir.) (medical products liability case; applying New Mexico law to hold that plaintiffs claim was time-barred, where plaintiff had long known of her injury and of its “specific cause”), cert. denied, — U.S. -, 115 S.Ct. 295, 180 L.Ed.2d 209 (1994); Burgess v. Eli Lilly & Co., 66 Ohio St.3d 59, 60, 609 N.E.2d 140, 141 (1993) (DES case; construing statute of limitations in context of state constitution’s “right-to-remedy” clause to hold that “[a] cause of action based upon DES exposure accrues only when the plaintiff has been informed by competent medical authority that she has been injured by DES, or upon the date on which, by exercise of reasonable diligence, she should have known that she has been so injured”); Baumgart v. Keene Bldg. Prods. Corp., 430 Pa.Super. 162, 171, 633 A.2d 1189, 1193 (Super.Ct.1993) (asbestos case; limitations period is triggered when plaintiff is aware of his injury and its cause, or where the “ ‘the information, through the exercise of due diligence, was knowable to the plaintiff ”); Burnside v. Abbott Lab., 351 Pa.Super. 264, 291, 505 A.2d 973, 977-78 (Super.Ct.1985) (DES case; statute of limitations period triggered when plaintiff “knows or reasonably should know” the fact of her injury and “ “who or what caused it’ ”); Anthony v. Abbott Lab., 490 A.2d 43 (R.I.1985) (DES case; “[I]n a drug product-liability action where the manifestation of an injury, the cause of that injury, and the person’s knowledge of the wrongdoing by the manufacturer occur at different points of time, the running of the statute of limitations would begin when the person discovers, or with reasonable diligence should have discovered, the wrongful conduct of the manufacturer.”); Reichelt v. Johns-Manville Corp., 42 Wash.App. 620, 712 P.2d 881 (App.1986) (asbestos ease; limitations period triggered when plaintiff discovers, or should have discovered “all the essential elements of his cause of action,” including the fact of his injury, the injury’s cause by a defective product and the identity of the manufacturer), aff'd in part, rev’d in part on other grounds, 107 Wash.2d 761, 733 P.2d 530 (1987); Michael A. Pretl & Heather A. Osborne, Trends in US Drug Product Liability—The Plaintiff’s Perspective, in Product Liability, Insurance and the Pharmaceutical Industry: An Anglo-American Comparison 109, 117 (Geraint G. Howells ed., 1991) “The discovery rule takes several forms among the different states, moving slowly toward a standard whereby the plaintiff must appreciate not only the causal relationship of the product to the injury but also product defect or manufacturer wrongdoing, before the action is barred.” (citing Vinson & Slaughter, Products Liability: Pharmaceutical Drug Cases § 3.01 et seq. (1988)); cf. Hadden v. Eli Lilly & Co., 208 N.J.Super. 716, 720, 506 A.2d 844, 846 (Super.Ct.App.Div.) (DES case; “The discovery rule permits deferral of the accrual of a cause of action until the injured person knows or should know that he has sustained an injury or knows or should know that an injury of which he is aware is attributable to the fault of another person.”), certification denied, 104 N.J. 441, 517 A.2d 431 (1986); Cavanaugh v. Abbott Lab., 145 Vt. 516, 496 A.2d 154 (1985) (DES case; adopting discovery rule and declining to reach issue of whether knowledge of the cause is required to trigger the statute of limitations, where plaintiff’s claim was timely in any event). Of those jurisdictions that have not considered discovery rules in the specific context of latent injuries, many have adopted discovery rules for products liability and personal injury actions that require knowledge of both the medical problem and its cause. See 54 Corpus Juris Secundum § 167, at 215 & n. 96 (1986) and cases cited therein; id. § 169, at 218-19 & nn. 41-42 and cases cited therein. But cf. Condon v. A.H. Robins Co., 217 Neb. 60, 68, 349 N.W.2d 622, 627 (1984) (IUD case; “Discovery ... refers to the fact that one knows of the existence of an injury or damage and not that one knows he or she has a legal right to seek redress in the courts.”). As these cases demonstrate, the American rule of discovery for statute of limitations purposes requires knowledge — or its handmaiden, reasonable diligence in obtaining such knowledge — both of the “injury” and its unnatural cause. The legislature and Governor must have had this rule in mind when they adopted section 214-c. A question left unanswered in the discussion preceding adoption of section 214-c, and elsewhere in the meager legislative history, is how far into the mainstream the legislature wanted to bring New York’s handling of these issues. e. Policy Given the arguably ambiguous language of the statute and the lack of clear legislative design, policy must guide construction of the statute. Policy dictates that in construing statutes of limitations, plaintiffs should not unreasonably be denied recovery and defendants should not have to litigate stale claims. See Duffy v. Horton Memorial Hosp., 66 N.Y.2d 473, 476-77, 497 N.Y.S.2d 890, 892-93, 488 N.E.2d 820 (1985) (“[T]he primary purpose of a limitations period is fairness to a defendant.... There is also the need to protect the judicial system from the burden of adjudicating stale and groundless claims.” (citations omitted)); Rothstein v. Tennessee Gas Pipeline Co., 204 A.D.2d 39, 616 N.Y.S.2d 902, 904 (App.Div. 2d Dep’t 1994) (remedial nature of section 214-c requires liberal construction). Turning to the policy favoring plaintiffs’ reasonable recovery for injuries suffered at the hands of malefactors, the guiding principle is that plaintiffs should not be penalized for failing to bring an action where they lacked information about the human source of their medical problems through no fault of their own. In the absence of determinative legislative history, the question of how much practical effect to give to this guiding principle is left to the courts. Plaintiffs’ reasonable awareness of the role of a human element in their medical problems is the minimum requirement for “discovery” under the statute. Cf. Schwartz v. Heyden Newport Chem. Corp., 12 N.Y.2d 212, 219, 237 N.Y.S.2d 714, 719, 188 N.E.2d 142, 145 (1963) (“[I]t would be unreasonable and perhaps unconstitutional to hold that [plaintiff’s] time to sue expired before it was possible for him to learn of the wrong....”) (Desmond, C.J., and Fuld, J., dissenting) (citations omitted), cert. denied, 374 U.S. 808, 83 S.Ct. 1697, 10 L.Ed.2d 1032 (1963). A plaintiff who is aware that she has a medical problem, but who does not know that it resulted from a human cause, is, as a practical matter, in no better position to file suit than a plaintiff who does not know that she has a medical problem. Where a plaintiffs ignorance about the human cause of her problems is reasonable and due to no fault of her own — either because such information was once unknowable, see N.Y.Civ.Prae.L. & R. 214 — c(4), or because of other factors to be considered in a moment — it is both inconsistent with the guiding principle and cruel to start the limitations clock ticking on the mere manifestation of a medica