Medical liability: Court strikes down noneconomic damages cap

The Supreme Court of Missouri has thrown out the state’s $350,000 noneconomic damages cap on medical lawsuits. After prior court decisions upholding the award limit, physicians said the ruling came as a surprising blow.

“It’s extremely disappointing,” said Tim Holloway, executive vice president of the Missouri State Medical Assn. The association, along with the Litigation Center of the American Medical Association and the State Medical Societies, had issued a friend-of-the-court brief urging the court to uphold the cap. “We feel like the court ignored years and years of precedent. [The ruling] portends another lawsuit crisis.”

The decision stems from a lawsuit filed by Deborah Watts against Lester E. Cox Medical Centers and medical center physicians. Watts claimed that negligence by hospital staff led to her son being born with disabling brain injuries. The center is part of the CoxHealth system.

A jury awarded Watts $1.5 million in noneconomic damages and $3.4 million for future medical expenses. A court reduced the noneconomic damages award to $350,000 in accordance with the state’s statutory limit. Watts appealed, arguing that the cap was unconstitutional because it violated plaintiffs’ right to a trial by jury.

In its July 31 opinion, the state high court said Missouri law long has recognized that a primary jury function is determining plaintiffs’ damages.

“Like any other type of damages, the amount of noneconomic damages is a fact that must be determined by the jury and is subject to the protections of” state law, judges said in their ruling. “The individual right to trial by jury cannot ‘remain inviolate’ when an injured party is deprived of the jury’s constitutionally assigned role of determining damages according to the particular facts of the case.”

The ruling means that the trial rights of Missouri citizens have been restored, said Andre Mura, an attorney with the Center for Constitutional Litigation, a civil rights law firm that represented the plaintiff.

“There isn’t justification for limiting compensation for someone who is injured,” he said. “A lot of the claims made by proponents of these [caps] are exaggerated and do not find support in empirical studies.”

The ruling probably will lead to more frivolous lawsuits against physicians and an increase in liability insurance premiums, Holloway said. Before the 2005 cap was enacted, lawsuits caused doctor shortages across the state and led to access-to-care issues, he said.

The ruling “turns back the clock to a time when a medical lawsuit crisis had pushed Missouri doctors to the breaking point,” MSMA President Stephen Slocum, MD, said in a statement.

Doctors are calling on the state General Assembly to make restoration of the cap a high priority in 2013. “This is an issue that impacts every Missourian,” Dr. Slocum said. “For the sake of their constituents, our elected officials must repair what the Supreme Court has done.”

At this article’s deadline, the Missouri attorney general’s office, which represented the doctors in the case, had not returned messages seeking comment.

Caps challenged in other states

Some state court decisions have upheld damages caps in the past year.

In March, the Supreme Court of Louisiana reaffirmed the state’s $500,000 limit on total medical liability damages, declaring the cap constitutional. In 2011, the Court of Appeal of the State of California, 5th Appellate District, upheld the state’s $250,000 noneconomic damages cap.

Cap challenges are pending in other states, including Indiana, Kansas and Mississippi.

In Indiana, judges heard oral arguments in May on the state’s $1.25 million total damages cap. Mississippi judges heard arguments in June 2011 on the state’s $500,000 noneconomic award limit.

Kansas physicians probably have waited the longest of any state to learn whether the $250,000 noneconomic damages cap will stand. The Kansas Supreme Court heard arguments twice, most recently in February 2011. The anticipated ruling is believed to be the longest-pending decision of any court case in the state, said Jerry Slaughter, executive director of the Kansas Medical Society.

“When or if [the cap] is struck down, we don’t know if it will apply to all cases pending or all cases going forward,” he said. “It’s created a great deal of uncertainty about the medical liability environment.”