Some are worried about the precedent of the decision. President Brett Emison of the Missouri Association of Trial Lawyers said the court allowed the legislature to “erase centuries-old common law and replace it with a statute that fundamentally infringes on the right to trial.”

In 2015, Missouri’s Republican-controlled House and Senate passed a maximum limit on noneconomic damages in medical malpractice cases. The law specifically removed the common law cause of action for medical negligence and replaced it with statutory cause.

With regard to damages under the new cause of action, no one can recover more than:

  • $400,000 in noneconomic damages for personal injury
  • $700,000 in noneconomic damages for catastrophic personal injury or
  • $700,000 for noneconomic damages for death

The law also calls for those limitations to increase by 1.7% each year.

When a medical malpractice case goes to a jury, the lawyers and judge don’t inform the jury of this limit. Instead, the jury decides what it believes to be the appropriate amount of damages. If noneconomic damages are greater than the statutory limit, the trial court determines if the limitation applies.

In 2017, a patient sued based on negligent care during her C-section birth and postpartum care. The case went to the Missouri Supreme Court, which found the damage cap didn’t violate the state constitution.

Patient Challenges Missouri’s Medical Malpractice Damage Cap

Maria del Carmen Ordinola Velazquez filed a medical negligence case against University Physician Associates and various doctors. She alleged the defendants were negligent during her C-section and postpartum care at Truman Medical Center in Kansas City, Missouri.

At trial, the jury found the defendants 100% at fault and awarded the plaintiff:

  • $300,000 in past economic damages
  • $300,000 in past noneconomic damages and
  • $700,000 in future noneconomic damages

The defendants filed motions to reduce the total noneconomic damages to $400,000 based on the statutory damage caps. The plaintiff filed a constitutional objection to the noneconomic damages cap. Alternatively, the plaintiff argued the higher cap for catastrophic personal injury applied.

The circuit court declined to find the cap unconstitutional. The court then awarded the plaintiff the higher noneconomic damages cap for catastrophic injury.

Missouri Supreme Court Upholds the Damage Cap

The plaintiff appealed the change to her damages, and the circuit court transferred the case to the Missouri Supreme Court.

The Supreme Court found the damage cap didn’t violate the constitution based on their holding in a previous case.

In Sanders v. Ahmed, the Supreme Court held “[t]he legislature has the power to define the remedy available if it creates the cause of action… The legislature, in so doing, at least in regard to a statutorily created cause of action… limited the substance of the claims themselves, as it has a right to do in setting out the parameters of a statutory cause of action.”

In other words, it isn’t unconstitutional for the legislature to limit a statutory cause of action it created.

A Brief History of Medical Malpractice Damage Caps in Missouri

The 2015 law wasn’t Missouri’s first attempt to limit medical malpractice damages. Nine years ago, the Supreme Court held a similar law was unconstitutional.

The difference between the previous and current statutes is that the more recent law doesn’t limit a common law action. Instead, it specifically repealed the common law claim and replaced it with a statutory cause of action.

“Because a medical negligence action is a statutorily created cause of action, the General Assembly had the legislative authority to enact statutory non-economic damage caps,” wrote Judge Zel M. Fischer.

States Are Divided on Damage Caps

Missouri isn’t alone in implementing a damage cap. Eight states limit noneconomic damages for all torts, not just medical malpractice. The states that have set a limit are Alaska, Colorado, Hawaii, Idaho, Maryland, Mississippi, Ohio, and Tennessee.

On the other hand, Florida, Illinois, Kansas, New Hampshire, Oklahoma, Oregon, and Washington courts have found general tort caps unconstitutional. Their state legislatures haven’t repassed new laws.

Many states choose to provide a maximum for medical malpractice damages, either for all damages or non-economic damages.

Like Missouri, 22 other states limit noneconomic damages in medical malpractice cases: Alaska, California, Colorado, Hawaii, Iowa, Idaho, Massachusetts, Maryland, Michigan, Mississippi, Montana, North Carolina, North Dakota, Nevada, Ohio, South Carolina, South Dakota, Tennessee, Texas, Utah, West Virginia, and Wisconsin.

Does Missouri’s Damage Cap Impact Medical Experts?

There are no doubts that Missouri’s damage cap impacts patients. It doesn’t apply to economic damages, which means plaintiffs can recover fully for their medical expenses and other financial losses. However, they may not feel they receive full justice based on limited noneconomic damages.

However, this isn’t an issue for medical experts. During a medical malpractice claim, medical experts inform the jury about the standard of care, deviation from that standard, and causation. It’s their job to explain the medical issues to the jurors who lack medical training.

Medical experts should remain focused on providing clear, accurate information. Leave the potential amount of damages up to the judge and jury.

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