In its opinion filed on April 19, 2016, the Supreme Court of Missouri (“Missouri Supreme Court”) upheld a constitutional challenge to Missouri’s cap on noneconomic damages in wrongful death claims, holding that the statutory limit does not violate the state constitutional right to a jury trial, the cap does not violate equal protection or separation of powers, and that the trial court did not err in granting a directed verdict on the issue of “aggravating circumstances” damages at the close of all of the evidence.
The Underlying Facts
A woman being treated in a Missouri hospital for bronchitis was given a stress echocardiogram that indicated that she might have some abnormalities. During a heart catheterization procedure, the left main coronary artery of her heart was dissected, cutting off blood flow to part of her heart. The physician called for assistance but no attempt was made to open the artery until about 30 minutes after the dissection occurred. Attempts to place a stent in the artery were unsuccessful and the woman died as a result of the dissection.
The woman’s husband and children filed a Missouri wrongful death action against the physician who had dissected the woman’s left main coronary artery and his employer. The trial court directed a verdict in favor of the defendants on the family members’ claim for aggravating circumstances damages at the close of all of the evidence, finding that the law did not support such damages in this case.
The Missouri medical malpractice jury returned a verdict in favor of the family members on their negligence claim, awarding them more than $1.83 million in total economic damages and $9 million in total noneconomic damages. The court reduced the noneconomic damages award to $350,000 pursuant to section 538.210.1, RSMo.
Missouri’s Cap On Noneconomic Damages
Section 538.210 states, in part:. 1. A statutory cause of action for damages against a health care provider for personal injury or death arising out of the rendering of or failure to render health care services is hereby created, replacing any such common law cause of action. The elements of such cause of action are that the health care provider failed to use that degree of skill and learning ordinarily used under the same or similar circumstances by members of the defendant’s profession and that such failure directly caused or contributed to cause the plaintiff’s injury or death.
2. (1) In any action against a health care provider for damages for personal injury arising out of the rendering of or the failure to render health care services, no plaintiff shall recover more than four hundred thousand dollars for noneconomic damages irrespective of the number of defendants.
(2) Notwithstanding the provisions of subdivision (1) of this subsection, in any action against a health care provider for damages for a catastrophic personal injury arising out of the rendering or failure to render heath care services, no plaintiff shall recover more than seven hundred thousand dollars for noneconomic damages irrespective of the number of defendants.
(3) In any action against a health care provider for damages for death arising out of the rendering of or the failure to render health care services, no plaintiff shall recover more than seven hundred thousand dollars for noneconomic damages irrespective of the number of defendants.
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8. The limitations on awards for noneconomic damages provided for in this section shall be increased by one and seven-tenths percent on an annual basis effective January first of each year. The current value of the limitation shall be calculated by the director of the department of insurance, financial institutions and professional registration, who shall furnish that value to the secretary of state, who shall publish such value in the Missouri Register on the first business day following January first, but the value shall otherwise be exempt from the provisions of section 536.021.
9. In any claim for damages under this chapter, and upon post-trial motion following a jury verdict with noneconomic damages exceeding four hundred thousand dollars, the trial court shall determine whether the limitation in subsection 2 of this section shall apply based on the severity of the most severe injuries.
Right To A Jury Trial
The Missouri Supreme Court held that the section 538.210 cap on noneconomic damages in wrongful death cases does not violate the right to a jury trial, stating that the Missouri constitution’s right to a jury trial is preserved as it existed at common law before Missouri’s first constitution was adopted in 1820.
The Missouri Supreme Court stated that an action for wrongful death was not recognized at common law in 1820 when the state’s constitution was first adopted but, instead, is a statutory creation subject to statutory caps and limitations. (The Missouri Supreme Court held in a 2012 case that the statutory cap on damages violated the right to a jury trial in medical malpractice actions alleging personal injury claims, which were recognized at common law and were not subject to legislative limits on damages when the constitution was adopted in 1820 – section 538.210 was invalidated only to the extent that its limitations infringed on the right to a jury trial for common law personal injury actions.)
The Missouri Supreme Court held that the section 538.210 cap on noneconomic damages does not violate equal protection. Although the state and federal constitutions guarantee equal rights and opportunities under the law, these guarantees do not mean the state may never make distinctions between individuals or groups of people. The state may treat different groups differently, but it must have adequate justification to treat similarly situated persons differently.
The Missouri Supreme Court cited its 1992 case in which it rejected an equal protection challenge to the section 538.210 cap on noneconomic damages, noting that the legislature created the cap in an effort to reduce perceived rising medical malpractice premiums and to prevent physicians from leaving high risk medical fields. The Missouri Supreme Court stated that it is not for the Court to evaluate the wisdom or desirability of the legislature’s policy decisions.
Separation Of Powers
The Missouri Supreme Court held that the section 538.210 cap on noneconomic damages does not violate separation of powers. The limit on damages does not interfere with the jury’s ability to render a verdict nor the judge’s task of entering judgment; it rather informs those duties.
Aggravating Circumstances Damages
The Missouri Supreme Court held that the family members failed to prove, by clear and convincing evidence, that the medical providers acted with complete indifference to or conscious disregard for the woman’s safety, and that the trial court did not err in delaying its decision regarding the medical providers’ motion for directed verdict until after it heard the medical providers’ evidence.
Source Dodson v. Ferrera, SC95151.
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