JEFFERSON CITY • The Missouri Supreme Court struck down on Tuesday a $350,000 limit on jury awards for "pain and suffering" in medical malpractice cases, saying the law violates a patient's right to a jury trial.
The cap on malpractice awards was established by a 2005 state law that was championed by Republicans as part of a "tort reform" push.
In a 4-3 decision, the court said the cap "infringes on the jury's constitutionally protected purpose of determining the amount of damages sustained by an injured party," in cases involving medical errors.
The case stemmed from a lawsuit filed by Deborah Watts of Springfield, Mo., whose son, Naython, was born with catastrophic brain injuries at Cox South Hospital in 2006 after a delay in receiving an emergency C-section. A Greene County jury last year awarded Watts nearly $5 million, which was then reduced under the law.
The high court decision "ensures that Naython will receive the benefit of the jury's award for future medical care," according to the ruling written by Chief Justice Richard B. Teitelman.
"This is a really good day for the citizens of Missouri who believe in our Constitution," said Kansas City attorney Tim Dollar, president of the Missouri Association of Trial Attorneys.
Capping medical malpractice awards was the keystone of the Republicans' business-oriented agenda in 2005.
That legislation was pushed by then-Gov. Matt Blunt, a Republican, as a way to control rising medical malpractice insurance rates. Similar measures had been vetoed twice by Blunt's predecessor, Bob Holden, a Democrat.
Blunt, who now lives in Virginia, said Tuesday that the law he signed was "a thoughtful approach to addressing a lawsuit crisis in our state. This Missouri Supreme Court decision eliminating a key provision of that law will harm hospitals, doctors, nurses and patients and sends the wrong message to potential job creators about Missouri's legal climate."
Republican legislators expressed bitter disappointment Tuesday with the Supreme Court's ruling. They said they would consider asking state voters to amend the constitution to reinstate the caps.
House Judiciary Committee Chairman Stanley Cox, R-Sedalia, said the court had reversed a "well-reasoned decision" from 1992 that found damage caps did not violate the right to a jury trial.
Sen. Rob Schaaf, a physician and a Republican from St. Joseph, said that because of the decision, rural areas would return to the days when they could not keep specialists such as obstetricians and neurosurgeons.
"It's just outrageous," Schaaf said. "The Supreme Court's decision is ultimately going to translate into endangering the lives of Missourians and their health."
Schaaf said he would like to see the Legislature call itself into special session to place a constitutional amendment on the November ballot to restore the caps.
He said amending the constitution was the best option, because that way, whatever the Republican-dominated Legislature passes would go straight to state voters and would not need Democratic Gov. Jay Nixon's signature.
Four judges appointed by Democratic governors made up the court majority in Tuesday's decision.
Chief Justice Teitelman -- who was appointed by former Gov. Bob Holden -- was joined by Supreme Court Judges Laura Denvir Stith, another Holden appointee, and George W. Draper III, who was appointed by Nixon.
The fourth member of the majority was special judge Sandra C. Midkiff. A Jackson County circuit judge, Midkiff filled in for Supreme Court Judge Zel Fischer, who did not participate in the case. Judges do not give reasons why they sit out. Holden appointed Midkiff to the circuit bench.
The three judges who disagreed with part of the decision were Mary Russell, William Ray Price Jr. and Patricia Breckenridge. Russell was appointed by Holden, Price by Republican Gov. John Ashcroft and Breckenridge by Blunt.
One of the biggest supporters of the 2005 law imposing damage caps was the Missouri Chamber of Commerce and Industry. In a friend-of-the-court brief, the chamber contended that damages awarded by juries for pain and suffering are "highly subjective and inherently unpredictable."
"Such awards may occur when juries are improperly influenced by sympathy for the plaintiff, bias against a deep-pocket defendant, or desire to punish the defendant rather than compensate the plaintiff," the chamber's brief said.
The chamber said Tuesday's Supreme Court decision would provide a rallying cry for those who want to change the way judges are picked.
"Trial attorneys have regained their hold on our health care system through the actions of their friends on the bench," said Rich AuBuchon, the chamber's general counsel.
The most striking change brought by the law has been the number of lawsuits filed, from a yearly average of 847 before tort reform to an average of 643 after, according to an analysis by the Missouri Foundation for Health.
About 1 percent of all such lawsuits result in a jury verdict for the plaintiff, a figure that has held steady after the law. The average jury award for pain and suffering has fluctuated but has not reached the high of $314,000 in 2002 since the law was passed.
The cap did little to reduce health care costs, said Jeffrey Herman, a St. Louis attorney who wrote the analysis for the health foundation.
"The damage cap itself really had a negligible impact on premiums, and the insurance companies remained so profitable," Herman said.
Plaintiffs' attorneys and patient advocates who opposed the cap said it targeted children, older people and the disabled who tend to be awarded damages for pain and suffering and not lost wages or future earnings.
The lack of a cap could lead to fewer medical errors, Herman said.
"You could argue that medical errors would decrease because if doctors are held to compensate plaintiffs for the full amount of injuries they would be more likely to act cautious," he said.
Attorneys said they interpreted the ruling to apply only to malpractice cases where plaintiffs had been injured, and that it did not apply to wrongful death lawsuits. It also does not affect current caps on punitive damages.
Before the 2005 law, Missouri had an inflation-adjusted cap of $579,000 for noneconomic damages in medical malpractice cases. The law lowered that to a flat $350,000 and applied the cap to the total amount owed by all defendants rather than against each defendant for each act of negligence as had been permitted under the old law.
The ruling cheered Sue Stratman, who testified against the 2005 law. Stratman's son, Daniel, now 27, suffered severe brain damage from a medical error during surgery at St. Louis Children's Hospital in 1996. Stratman, who settled with the defendants in their case, estimates the family has since spent millions of dollars on Daniel's care.
"What a victory for victims," Stratman said. "We're not talking about frivolous lawsuits here, we're talking about serious medical malpractice injuries that affected my son for the rest of his life. He will never be able to live on his own, he will never be able to work, he requires 24-hour constant care. If this were your son, how much is too much?"
The Associated Press contributed to this report.
Source: St. Louis Post Dispatch