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Missouri overturns limits on noneconomic damages
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Earlier this year, the Missouri Supreme Court removed a $350,000 limit on noneconomic medical malpractice damages. As expected, this was a contentious ruling issued by a court split neatly along partisan lines.
In this month’s Orthopedic Medical Legal Advisor column, we examine both sides the arguments, i.e., those offered by the majority opinion written by Chief Justice Richard Teitelman and the dissent authored by Justice Mary Russell.
Plaintiff Deborah Watts was treated at a facility owned by Cox Medical Centers in Springfield, Mo., during her pregnancy. At 39 weeks, Watts was seen by a third-year resident physician for complaints related to cramping and decreased fetal movement. The records show that at the time, the resident neither performed further testing or monitoring, nor notified Watts of the significance of decreased fetal movement. The supervising attending physician signed off on this course of treatment. The next day, Watts was admitted to the hospital due to lack of fetal movement and monitoring showed fetal hypoxia and acidosis. The C-section delivery did not occur until more than 1.5 hours later, and infant Naython Watts was born with catastrophic brain injuries and permanent disabilities resulting from such.
At jury trial, Watts was awarded $1.45 million in noneconomic damages, in addition to $3.371 million in future medical damages. After the trial, the trial court judge reduced the amount to the statutorily prescribed limit of $350,000, consistent with state law. Watts appealed, arguing that the caps set forth by Missouri law violated her rights under the state constitution.
B. Sonny Bal
Lawrence H. Brenner
History of damage caps
The Missouri legislature had instituted limits on noneconomic damages in medical malpractice cases for a long time. Before 2005, the caps adjusted for inflation and were approximately $579,000. After 2005, the legislature limited damages by lowering the caps to $350,000, eliminated adjustment for inflation, and set forth a single cap for all defendants in cases involving multiple defendants. In essence, the Missouri legislature said that regardless of jury verdicts, it would determine the maximum monetary award for noneconomic damages.
The advocacy of Missouri damage caps in 2005 was promoted by a special interest coalition that included the Chamber of Commerce, insurance companies and medical associations. During legislative hearings on the bill, these organizations claimed there was a nationwide litigation crisis and excessive jury awards that threatened the delivery of health care. These groups called for caps of $250,000 for noneconomic damages that included pain and suffering. Some claimed physicians were leaving states without such caps on damages, closing their practices, or practiced defensive medicine by ordering excessive and unnecessary tests and procedures.
Other parties and scholars, led by law Professor Neil Vidmar from Duke University offered a different perspective. These parties filed an amicus brief pleading that no medical malpractice lawsuit crisis had ever existed in Missouri, and the rationale offered for damage caps was faulty. Amici offered statistics compiled in the American Medical Association’s authoritative annual compendium, showing the number of physicians actively practicing patient care in Missouri increased even during the alleged periods of the so-called litigation crisis, both in terms of absolute numbers and relative to Missouri’s population.
Constitutional provisions
The Missouri Constitution was adopted in 1820, and Missouri’s common law is based on the common law of England as of 1607. English common law recognized medical negligence as one of the five types of private wrongs that could be redressed in court. Similarly, Missouri’s territorial laws that predated its statehood provided for jury trials in “all civil cases of the value of one hundred dollars…if either of the parties require it.”
A remittitur is a ruling by a judge (usually upon motion to reduce or throw out a jury verdict) that lowers the amount of damages granted by a jury in a civil case. As in many other states, judicial remittitur in civil cases was an established concept in Missouri’s common law. Remittitur is a judicial remedy that allows the court to correct runaway jury verdicts driven by prejudice or passion, or verdicts that are inconsistent with facts and mathematical calculations.
In her appeal, Watts asserted the $350,000 cap on noneconomic damages established by Missouri law violated the right to trial by jury that is guaranteed by article I, section 22(a) of the Missouri Constitution, which provides that “the right of trial by jury as heretofore enjoyed shall remain inviolate ….” Respondents Cox and others relied on a 1992 ruling by the Missouri Supreme Court, titled Adams v. Childrens’ Mercy Hospital, where the court had held that the statutory cap on noneconomic damages did not violate the right to trial by jury. While respondents urged the court to hold the Adams ruling dispositive, appellant Watts argued that the court had decided Adams wrongly, and that Adams should be overruled.
Writing for the majority, Chief Justice Richard Teitelman said that the court was overturning erroneous precedent that violated a constitutional right. Justice Teitelman said that removing a jury’s ability to decide the amount of damages owed to an injured party is a violation of a citizen’s “inviolable right” to a trial by jury for noneconomic medical malpractice damages.
“While this court always is hesitant to overturn precedent, it nonetheless has followed its obligation to do so where necessary to protect the constitutional rights of Missouri’s citizens,” he said in the ruling.
In denying remittitur of the noneconomic damages determined by the Watts jury, the court observed that statutory damage caps neither existed, nor were contemplated by the people of Missouri when they adopted their constitution in 1820, guaranteeing that the right to trial by jury. Specifically, the Watts court said the right to trial by jury “heretofore enjoyed” by Missouri citizens was not subject to legislative limits on damages. Noting that the jury’s function included a determination of the plaintiff’s damages, the court found that statutory caps prescribed under state law contravened the right of Missouri citizen to a trial by jury, subject only to judicial remittitur based on evidence in the case. Thus, statutory caps on damages were not permissible in 1820, and therefore, remained just as impermissible in 2012.
Proponents of the decision argued that in overturning the cap, the Watts decision preserved and upheld the right to trial by jury that has been held inviolate in Missouri since its original constitution in 1820. The U.S. Supreme Court confirmed the right to trial by jury includes the duty of the jury to determine actual damages inflicted on the injured victim.
“The plaintiff has the full benefit of that right free from the reach of hostile legislation,” the U.S. Supreme Court held.
The erroneous precedent that the court referred to in Watts was its earlier ruling in Adams. In that legal case, an 8-year-old girl had serious burns from hot grease when she slipped near the family stove while practicing for an upcoming dance recital. During subsequent surgery for skin grafts at Childrens’ Mercy Hospital in Kansas City, too much crystalloid fluid was administered. When the endotracheal tube was removed, the trachea swelled shut, causing serious hypoxic brain damage. The jury awarded $20 million in damages, including $13 million in noneconomic damages that were reduced by the trial court, in compliance with statutory damage caps. In Adams, as in Watts, the appellant raised constitutional challenges to the damage caps.
The Adams court found damage caps to be rationally related to the general goal of preserving adequate, affordable health care for all, and upheld such caps. The court said the constitutional guarantee of the right to a jury trial has remained the same through four Missouri constitutions commencing with the Constitution of 1820. A jury’s primary function is fact finding that includes a determination of a plaintiff’s damages. In arriving at a verdict, the Adams jury assessed liability and then determined damages, both economic and noneconomic. According to the court, with that the jury completed its constitutional task, leaving the court to apply the law to the facts.
The Adams court went on to say that legislatively prescribed damage caps establish the substantive, legal limits of the plaintiffs’ damage remedy. In this sense, the permissible remedy is a matter of law, not fact, and not within the purview of the jury. Furthermore, because the Missouri legislature has the constitutional right to abrogate a cause of action cognizable under common law completely, the legislature also has the power to limit recovery in those causes of action. The constitutional attack raised on damage caps invoked by appellants in Adams was thus denied.
In writing for the dissent, Justice Mary Russell invoked the Chief Justice of the United States, John Roberts when he wrote for the majority in upholding health care reform earlier this year. In the contentious split-court ruling titled National Federation of Independent Business v. Sebelius, Justice Roberts said that courts have “the authority to interpret the law;” but “[courts] possess neither the expertise nor the prerogative to make policy judgments. Those decisions are entrusted to our … elected leaders ….It is not [a court’s] job to protect the people from the consequences of their political choices.” Justice Russell agreed and said that whether a legislatively prescribed limitation on the amount of noneconomic damages an injured person can receive in a tort action is good policy is not for the court to decide.
The dissent frowned upon the majority opinion’s disregard of stare decisis (legal principle by which judges are obliged to respect the precedent established by prior decisions), and well-established Missouri law in overturning the Adams ruling. According to the dissent, as long as the jury finds the facts and the trial court does not interfere with the jury’s fact finding; the jury has served its constitutional task. The trial court’s application of the law to the facts after they have been found by the jury does not harm to the right to a trial by jury. Finally, the dissent noted that the earlier Adams ruling was consistent with similar judicial holdings in other states that had confronted the issue of constitutionality of damage caps.
What do you think?
Jury trial has is written as a fundamental right in our nation’s charter. Thomas Jefferson said that “I consider trial by jury as the only anchor ever yet imagined by man, by which a government can be held to the principles of its constitution.” John Adams remarked that “Representative government and trial by jury are the heart and lungs of liberty. Without them we have no other fortification against being ridden like horses, fleeced like sheep, worked like cattle, and fed and clothed like swine and hounds.”
- Do the words of the founding fathers overstate the case for trial by jury?
- Are noneconomic damages by jurors, especially vulnerable to passions and prejudices, stoked by the theatrics of counsel? If so, are legislatively prescribed damage caps the proper antidote to keep damages within reasonable limits?
- Does affordable health care delivery not demand some sort of cap on damages awarded to medical malpractice victims?
Discuss with your colleagues at www.OrthoMind.com.