Florida Supreme Court Rules Damages Caps Unconstitutional in Medical Malpractice Cases

Gavel and stethoscopeFormer Governor Jeb Bush pushed the legislature into three special sessions in 2003 to enact caps on non-economic recovery in medical malpractice cases. Readers might recall a tremendous amount of turmoil in the years leading up to this legislative change related to a purported "medical malpractice insurance crisis". There was hysteria and purported panic about certain medical specialists leaving the state because of high medical malpractice rates, particularly OB/GYN and neurosurgery. Caps were touted as the only way to bring malpractice insurance rates under control. Supporters of the proposed caps on medical malpractice damages also alleged without them emergency room doctors would flee Florida and emergency rooms would close. This was all very contentious since the effect of these changes was to place limits on the recovery of the most severely injured victims for their "non-economic" damages. Non-economic damages are generally considered to be the intangible losses commonly referred to as physical and mental pain-and-suffering, scarring, disfigurement and loss of the enjoyment of life.

What Florida did in 2003 was to enact damage caps in Florida Statutes Sections 766.118 (2) and (3). The damage caps for non-economic losses were a significant change over the prior law which did not limit someone's recovery. Florida set up a system of damage caps based on whether the medical practitioner at fault was an individual practitioner or hospital. Caps were as low as $500,000 for cases brought against an individual practitioner, such as an orthopedic surgeon or general surgeon. Damage caps, although higher, were limited to $750,000 and $1.5 million when the injury was the result of a claim against a non-practitioner such as a hospitals and similar institutions.

Unlike some other states, Florida made provision for damage caps up to $1 million if the negligence of one or more practitioners resulted in a permanent vegetative state or death or if the court determined that because of special circumstances of the case the non-economic loss sustained by the injured person was particularly severe and the jury found the defendant's negligence caused a catastrophic injury to the patient. Similarly, non-practitioner's (hospitals) had breakthrough caps of up to $1.5 million using similar criteria.

Injury lawyers who were opposed to the caps argued it was, at most, debatable whether they would lower insurance rates or make a significant difference in the number of doctors choosing to practice here. The Florida Supreme Court recently found in its 2014 Estate of McCall v. United States decision there was no evidence these caps had any effect on lowering malpractice insurance premium doctors were paying. At the same time these caps made a dramatic difference to the most severely injured patients. The effect of the caps was to arbitrarily limit what the most severely injured persons could recover. It also meant someone who had a significant injury could recover the full value of their loss if it was within the damage caps, while a person with a more catastrophic loss would be limited. It set up two classes of victims.

The most recent Florida Supreme Court decision which impacted the statute was issued in June 2017.  The injured plaintiff in North Broward Hospital District v. Susan Kalatin was a woman who was severely injured by doctors who performed carpal tunnel surgery on her wrist. Her esophagus was punctured during the surgery. The complication was not immediately discovered and she was sent home on pain medication only to be rushed back to the hospital for life-saving surgery. She was apparently left with physical limitations and pain as well as mental trauma. The jury awarded her $2 million for past pain-and-suffering and $2 million for future pain and suffering. Despite a finding by the judge in the trial court that her injuries were catastrophic, her non-economic award was reduced by about $3.3 million because of the caps.

The case was taken up on appeal and the appellate court agreed the medical malpractice caps were unconstitutional. As a result, it was appealed to the Florida Supreme Court, which issued its ruling on June 8, 2017, finding that the medical malpractice caps were unconstitutional.

The ruling by the Florida Supreme Court was not a dramatic surprise because of their 2014 ruling in the McCall case which found the cap on non-economic damages in wrongful death cases unjustly and unreasonably treated survivors of wrongful death actions differently. Florida had enacted limits on the recovery for survivors of victims of medical malpractice cases which placed similar caps on their non-economic losses. The court declared those caps to be unconstitutional in the McCall case.

In Kalitan the court recognized the limitations on economic recovery affected both the victims and those who caused the injury. People who caused less serious injuries would be fully responsible for the entirety of the victim's losses, whereas those who caused more severe injuries would benefit from the limits placed on non-economic damage recovery by their victims.

The court in Kalitan found the damage scheme outlined in the statute was unconstitutional because it violated equal protection under the Florida Constitution since there was no rational and reasonable relationship between the reduction of compensation which was without regard to the severity of injury. They also found the statute did not bear a rational relationship to the alleged medical malpractice crisis since the classification of awarding compensation under the statute unreasonably and arbitrarily limited recovery of those most grievously injured by medical negligence.

The effect of the court's ruling is to remove the damage caps on medical malpractice cases which occur after the date of the decision. The effect of the decision, however, should be to remove caps in all cases in which the medical negligence occurred before the date of the decision, but which had not yet been settled or tried.

This decision is a total game changer for victims of medical malpractice in Florida. While there was never a limit on economic damages, the actual cost of medical care, lost earning and other financial losses, no longer will insurance companies be in a position of avoiding full responsibility for compensating medical malpractice victims for the full measure of their non-economic damages as well.