As California Court Mulls Caps on Malpractice Awards, Some States Are Dropping Them

By Logan Quirk

Exactly three weeks after two-thirds of California voters who went to the polls in November voted down Proposition 46, a ballot initiative that would have overturned a 40-year-old ceiling of $250,000 on awards in medical malpractice cases for non-economic damages (such as pain and suffering), the California Supreme Court decided to take up a case (Hughes v. Pham) challenging the current limit as unconstitutional.


While the precise issues the high court will consider have not yet been identified, the top courts in several other states have recently acted to reject or revise provisions similar to those in California.

For example, the Illinois Supreme Court in 2010 voided a cap on non-economic damages on equal protection grounds, and Georgia’s high court cited the right to a jury trial in doing likewise the same year. Missouri in 2012 held the state legislature exceeded powers by trying to impose malpractice damage limits. In 2013, it was Oregon’s turn to reject caps of non-economic damages in malpractice cases, based on the state constitution-guaranteed right to trial by jury.

Most recently, and perhaps most significantly, the Florida Supreme Court in March 2014 threw out a 2003 state law imposing a ceiling on medical malpractice damages ($500,000 per claimant or care provider, with a $1 million overall cap). Remarkably, five of the seven Florida justices agreed in that case (Estate of McCall v. United States) the damages limit was unconstitutional. In doing so, the Florida high court may have opened new avenues of attack for opponents of malpractice damage caps.


Like many medical malpractice cases, McCall presented heart-breaking facts. Michelle McCall was 20-year-old Air Force dependent receiving pre-natal care for her first pregnancy at an Air Force base in Florida. One afternoon, she was admitted to the hospital, diagnosed with severe high blood pressure. Even though that calls for immediate delivery, she was left in the family medicine department, rather than transferred to the OB/GYN department.


When an Air Force obstetrician proved unavailable, rather than schedule a Caesarean delivery, the staff gave her drugs to induce labor. She delivered a healthy son early the next morning, but medical and nursing staff failed to monitor her vital signs as she suffered great loss of blood, went into shock and cardiac arrest, and was eventually removed from life support.


A wrongful-death Federal Tort Claim lawsuit was filed in federal court for the parents and the newborn son. The judge found malpractice and awarded economic damages of nearly $1 million and found non-economic damages of $2 million ($500,000 for the son and $750,000 for each of the parents), but cut them to $1 million, per Florida law. The family appealed; a federal appeals court ruled the damages cap did not violate the U.S. constitution’s equal-protection clause, but sent the case to the state high court to determine four issues on whether the damages cap violated the state constitution.


In a 50-page plurality decision, the Florida Supreme Court resolved only one of those questions, ruling the damages cap ran afoul of the state’s equal-protection clause; it described the cap as imposing “unfair and illogical burdens” on malpractice victims, and bearing no rational relationship to its intended purpose of controlling what it called the state’s “alleged medical malpractice insurance crisis,” and thus serving no legitimate state interest.


Only two justices joined the entire opinion, which was sharply critical of the state legislature, but three other justices agreed with the result without adopting all of its reasoning; two other justices would have upheld the state law. The decision only applies to malpractice giving rise to wrongful-death cases, but may mark a turning point in the fight over non-economic damages in malpractice cases.

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