Florida Supreme Court Decision Raises Concerns About the Constitutionality of Statutory Caps on Damages in Medical Malpractice Cases

The Supreme Court of Florida recently found Florida’s statutory caps on medical malpractice damages for pain and suffering (noneconomic damages) to be unconstitutional as violating the equal protection clause of the state’s constitution. This ruling is concerning for healthcare providers because, not only could it result in additional liability in malpractice cases, but it could also cause an increase in malpractice insurance premiums.

Like Louisiana, Florida law provides statutory caps on damages that may be awarded to plaintiffs in medical malpractice suits. However, Florida’s statute is more complex than Louisiana’s Medical Malpractice Act. Specifically, Florida’s law provides tiers of caps on damages.[1] For suits against practitioners,[2] damages for pain and suffering are capped at $500,000.00, regardless of the number of claimants. However, if the negligence resulted in a permanent vegetative state or death, or the practitioner’s negligence caused “catastrophic injury”[3] and manifest injustice would occur unless increased damages are awarded, the cap increases to $1 million. Similarly, for suits against nonpractitioners, damages for pain and suffering are capped at $750,000.00, and the cap is increased to $1.5 million in the event of death, permanent vegetative state, or “catastrophic injury” where manifest injustice would occur unless increased damages are awarded.

The Florida Supreme Court examined this tiered scheme in the recent North Broward Hospital District v. Kalitan decision.[4] There, the plaintiff, Susan Kalitan, presented to the defendant hospital for outpatient surgery to treat carpal tunnel syndrome in her wrist. During intubation, and unknown to the patient’s anesthesiologist, one of the tubes perforated the patient’s esophagus. After the surgery was completed, the patient complained of chest pain. The anesthesiologist examined her heart and determined that it was safe to discharge her. The anesthesiologist did not detect the perforation of the esophagus prior to discharge. The next day, Ms. Kalitan’s neighbor found her unresponsive and brought her to the emergency room, where she underwent lifesaving surgery to repair her esophagus. Ms. Kalitan was kept in a drug-induced coma for several weeks, and was required to undergo additional surgeries and intensive therapy.

Based on these events, Ms. Kalitan filed suit against the providers and the matter proceeded to trial. The ultimate question for the jury to decide was whether Ms. Kalitan’s injuries constituted a “catastrophic injury,” which would increase the cap on the damages she could be awarded to $1 million. The jury ultimately found that Ms. Kalitan had indeed suffered a “catastrophic injury,” and awarded her $4,718,011 in total damages (about $2 million for past pain and suffering and about $2 million for future pain and suffering). Based on the statutory cap, the award was reduced by roughly $2 million.

Both parties appealed this ruling, with the providers arguing that the jury erroneously found that a catastrophic injury had occurred, and Ms. Kalitan arguing that the statutory cap on damages for pain and suffering was unconstitutional. The Florida Supreme Court reviewed the issue of constitutionality and agreed with Ms. Kaltian’s position.

Specifically, the court applied the rational basis test to determine whether the statute violated the equal protection clause. The analysis is two-fold: (1) whether the statute bears a rational relationship to a legitimate state interest, and (2) whether the statute is imposed in an arbitrary and capricious manner. The court first considered the arbitrary and capricious element and found that the statute did not survive this inquiry. The providers argued that the state had a legitimate interest in imposing the subject statutory caps because there was a “medical malpractice crisis” in Florida in which insurance premiums for healthcare practitioners were astronomical. By reducing overall liability, it was believed that the cost of insurance would likewise decrease. This rationale was the Florida legislature’s ultimate purpose in enacting the statutory caps.

However, the Florida Supreme Court rejected this argument, finding that “there is no evidence of a continuing medical malpractice crisis justifying the arbitrary application of the statutory cap.”[5] The court determined that the distinction between classes of medical malpractice victims results in an arbitrary reduction of damages for the most drastically injured victims. For example, the statute “impose[s] equal caps on noneconomic damages in instances where a plaintiff suffers a permanent vegetative state, unquestionably a more serious injury, as in instances where a plaintiff suffers the amputation of a hand, if a court determines a manifest injustice would occur unless increased damages are awarded.”[6] Ultimately, the court held that the caps do not pass the rational basis test because, in the context of persons catastrophically injured by medical negligence:

…we believe it is unreasonable and arbitrary to limit their recovery in a speculative experiment to determine whether liability insurance rates will decrease. Moreover, we fail to see how singling out the most seriously injured medical malpractice victims for less than full recovery bears any rational relationship to the Legislature’s stated goal of alleviating the financial crisis in the medical liability insurance industry.[7]

The Florida Supreme Court also considered the legitimacy of the state’s objective in passing the statutory caps on damages (i.e. the medical malpractice crisis), and rejected that rationale for three reasons. First, it found that there was a lack of evidence demonstrating how the statutory cap alleviated the medical malpractice crisis. Second, even if the cap did result in decreased liability, the court noted that “there is no mechanism in place to assure that savings are passed on from the insurance companies to the doctors in accordance with the stated purpose of alleviating the rising premiums.”[8] Finally, the court found that, even if there was a medical malpractice crisis at the time the statute was passed, current data reflects that “it has subsided,” and, thus, no rational basis persists for the cap.[9] Based on this reasoning, the Florida Supreme Court found that the statutory caps were unconstitutional as violating the equal protection clause.

The Kalitan opinion raises concerns regarding the constitutionality of Louisiana’s statutory cap on medical malpractice damages. It should be noted, however, that Louisiana does not have a tiered cap scheme like Florida – rather, Louisiana’s Medical Malpractice Act provides that “the total amount recoverable for all malpractice claims for injuries to or death of a patient, exclusive of future medical care and related benefits…shall not exceed five hundred thousand dollars plus interest and cost.”[10] Arguably, the Kalitan reasoning would not apply in Louisiana because malpractice victims are not arbitrarily classified into groups based on the nature of their injuries. They are, however, separated under the law from other tort victims in the State, which could lead a court to find that the equal protection clause of the Louisiana constitution is violated. Moreover, a Louisiana court could find that the law fails constitutional scrutiny because there is no rational relationship to a legitimate state interest if it cannot be demonstrated that the statute achieves its purpose of mitigating the medical malpractice crisis in this State.

[1] Fla. Stat. Ann. §§ 766.118(2), (3).

[2] “Practitioner” includes physicians, osteopathic physicians, chiropractors, podiatrists, practitioners of naturopathy, optometrists, dentists, midwives, physical therapists, and nurse practitioners. “Practitioner” also means any association, corporation, firm, partnership, or other business entity under which such practitioner practices or any employee of such practitioner or entity acting in the scope of his or her employment. The term “practitioner” also includes any person or entity for whom a practitioner is vicariously liable and any person or entity whose liability is based solely on such person or entity being vicariously liable for the actions of a practitioner.

[3] “Catastrophic injury” is defined as a (1) spinal cord injury involving severe paralysis of an arm, a leg, or the trunk; (2) amputation of an arm, a hand, a foot, or a leg involving the effective loss of use of that appendage; (3) severe brain or closed-head injury as evidenced by severe sensory or motor disturbances, severe communication disturbances, severe complex integrated disturbances of cerebral function, severe episodic neurological disorders, or other severe brain and closed-head injury conditions at least as severe in nature as any condition specifically identified; (4) second-degree or third-degree burns of 25 percent or more of the total body surface or third-degree burns of 5 percent or more to the face and hands; (5) blindness, defined as a complete and total loss of vision; or (6) loss of reproductive organs which results in an inability to procreate.

[4] 2017 WL 2481225, — So.3d — (Fla. 2017).

[5] Id. at *6.

[6] Id.

[7] Id. at *7.

[8] Id. at *7.

[9] Id. at *8.

[10] La. R.S. 40:1231.2 (emphasis added).

Written by: Danielle L. Borel and Kelsey A. Clark

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