Missouri Supreme Court overturns med-mal damages cap

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August 16, 2012

Missouri Supreme Court overturns med-mal damages cap 

Steven M. Sellers

The Missouri Supreme Court overruled one of its own precedents and struck down a state statute that capped noneconomic damages in medical malpractice cases, restoring a jury award to a brain-injured boy. The 4-3 en banc decision held that the law’s $350,000 cap for noneconomic damages conflicted with the right to a jury trial under state common law and the Missouri constitution.  Andre Mura, litigation counsel at the Center for Constitutional Litigation in Washington, D.C., argued the appeal for the plaintiffs and anticipates that the decision may affect similar challenges now pending in Kansas and Mississippi.

Toppling a pillar of tort “reform,” the Missouri Supreme Court struck down a state statute that capped noneconomic damages in medical malpractice cases, restoring a jury award to a brain-injured boy. The 4-3 en banc decision held that the law’s $350,000 cap for noneconomic damages conflicted with the right to a jury trial under state common law and the Missouri constitution.  The court took the unusual step of overruling one of its own precedents in nullifying the statute “to the extent that it infringes on the jury’s constitutionally protected purpose of determining the amount of damages sustained by an injured party,” wrote Chief Justice Richard Teitelman in the majority opinion. (Watts v. Lester E. Cox Med. Ctrs., No. SC91867 (Mo. July 31, 2012).)

Judge Mary Russell filed a dissent, arguing that the majority violated the principle of stare decisis and improperly expanded the right to a jury trial to damages awards. She also noted that the court had recently upheld the statutory cap on noneconomic damages in wrongful death actions resulting from medical negligence, which have no common law antecedent in Missouri. (Sanders v. Ahmed, 364 S.W.3d 195 (Mo. 2012).)

Naython Watts was born in 2006 with disabling brain injuries caused by medical negligence. Physicians failed to perform necessary tests when Deborah Watts reported decreased fetal movement and delayed diagnostic monitoring until the next day. Those tests revealed fetal hypoxia and acidosis requiring an immediate cesarean section, but doctors delayed the delivery for nearly two more hours, resulting in catastrophic brain injuries to Naython. A jury awarded $3.371 million in future medical damages and $1.45 million in noneconomic damages, but the trial court reduced that award to $350,000 pursuant to the statutory cap enacted in 2005.

The appeal brought the Missouri state constitution—and its guarantee that “the right of trial by jury as heretofore enjoyed shall remain inviolate”—to the forefront. Tracing the history of Missouri law in medical negligence cases, Teitelman found ample evidence that the state’s common law entitled a plaintiff to a jury trial on the issue of noneconomic damages in a medical negligence action when the Missouri constitution was adopted in 1820. He explained that the prevailing common law at that time was founded on the common law of England in 1607, which recognized medical negligence as one of five types of “private wrongs” that could be redressed in court. Teitelman added that even before its statehood, Missouri’s territorial laws called for jury trials in “all civil actions of the value of one hundred dollars . . . if either of the parties require it.”

The defendants—Lester E. Cox Medical Centers and the three physicians who treated Deborah and Naython Watts—relied heavily on Adams v. Children’s Hospital (832 S.W.2d 898 (Mo. 1992)). In that case, the Missouri Supreme Court held that the statutory cap on noneconomic damages did not interfere with the right to a jury trial because the cap is applied after a jury renders its decision on damages. They also had the support of amicus curiae briefs filed by the U.S. Chamber of Commerce, the American Medical Association, the Missouri Organization of Defense Lawyers, and the American Congress of Obstetricians and Gynecologists.

The majority was not persuaded. Agreeing with the plaintiffs that Adams was wrongly decided and should be overruled, Teitelman expounded on “flaws” in its rationale. “Because the right to a civil jury trial is contingent upon there being an action for damages,” Teitelman wrote, “statutory limits on those damages directly curtail the individual right to one of the most significant constitutional roles performed by the jury—the determination of damages.” The majority faulted Adams for its improper “legislative limitation of an individual constitutional right” and its disregard for common law rights that predated the state constitution.

The majority opinion also found error in the trial court’s application of the periodic payment schedule specified in the statute. The plaintiffs contended that the 50-year payment schedule effectively deprived Naython of the full amount of compensation the jury awarded and the majority agreed that the schedule, coupled with a 0.26 percent interest rate, “virtually guaranteed that inflation in health care costs would result in Naython having insufficient funds to pay his future medical costs.” The court remanded the case for a new payment schedule “consistent with the goal of reducing medical malpractice costs” and ensuring that Naython “will receive the benefit of the jury’s award for future medical care.”

Andre Mura, litigation counsel at the Center for Constitutional Litigation in Washington, D.C., argued the appeal for the plaintiffs. “Those who believe that constitutional interpretation should be based on text and original meaning should be pleased with the ruling in Watts that caps violate the ‘inviolate’ right to jury trial, as that right was understood in 1820,” said Mura. “The case is also significant because the court overruled a 20-year-old precedent that had departed from the constitutional text and had diminished the constitutional right.” Mura anticipates that the decision may have an effect on similar challenges now pending in Kansas and Mississippi.


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