The Florida Supreme Court has ruled that the state’s caps on noneconomic damages in medical malpractice wrongful death cases violate the state Constitution’s equal protection clause.

The 5-2 opinion held that the way the caps reduce damages “is not only arbitrary, but irrational” and it “offends the fundamental notion of equal justice under the law.”

“The statutory cap on wrongful death noneconomic damages fails because it imposes unfair and illogical burdens on injured parties when an act of medical negligence gives rise to multiple claimants,” the court ruled.

The ruling wipes out provisions capping payments for pain and suffering in wrongful death cases to $500,000 or $1 million, depending the number of medical providers or plaintiffs involved.

The caps were part of tort reforms supported by former Gov. Jeb Bush back in 2003 at a time when advocates for damages caps said the state faced a medical malpractice insurance crisis with doctors leaving the state and refusing to provide certain high-risk services because of high insurance costs.

The high court has now not only rejected the damages caps as a solution but also questioned whether there really ever was a crisis.

In explaining why the damages cap violates the state’s equal protection clause, the court opinion, written by Justice R. Fred Lewis, says the statute “has the effect of saving a modest amount for many by imposing devastating costs on a few —those who are most grievously injured, those who sustain the greatest damage and loss, and multiple claimants for whom judicially determined noneconomic damages are subject to division and reduction simply based upon the existence of the cap.”

The court discounted what it termed the “alleged medical malpractice crisis” that lawmakers used to justify passing the statute. The court said that there was insufficient evidence that there was a crisis or that damages caps would lower malpractice premiums or help alleviate it. Also, the court said, even if there was a crisis to justify caps in 2003, there is no crisis now.

The damage caps violate Florida’s Equal Protection Clause “because the available evidence fails to establish a rational relationship between a cap on noneconomic damages and alleviation of the purported crisis,” according to the opinion.

Federal Court

The case was filed by the estate of Michelle McCall, McCall’s parents, and the father of McCall’s son. McCall died in 2006 after receiving prenatal care at a United States Air Force clinic.

The plaintiffs filed an action against the United States under the Federal Tort Claims Act. A federal district court concluded that the petitioners’ noneconomic damages totaled $2 million, including $500,000 for McCall’s son and $750,000 for each of her parents.

However, the district court limited the recovery of wrongful death noneconomic damages to $1 million upon application of Florida’s statutory cap on wrongful death noneconomic damages.

The McCalls appealed to the Eleventh Circuit, contesting the constitutionality of the cap. They contended that the statutory cap violates the U.S. Constitution and several provisions of the Florida Constitution.

The Eleventh Circuit held that the cap does not violate the U.S. Constitution. However the federal court granted the plaintiffs’ request to ask the Florida Supreme Court about the constitutionality of the caps under the Florida Constitution.

‘Irrational’ Effect

The Florida Supreme Court said the statute on damages “irrationally” affects cases where there are multiple parties less favorably than those with a single claimant and it also “exacts an irrational and unreasonable cost and impact when, as here, the victim of medical negligence has a large family, all of whom have been adversely impacted and affected by the death.”

The damages suffered by McCall’s parents were determined to be $750,000 each, and McCall’s surviving son sustained damages determined to be $500,000. Applying the cap, the federal court then reduced the amounts so each claimant would receive only half of his or her respective damages. If McCall had been survived only by her son, the Florida court calculated, he would have recovered the full amount of his noneconomic damages: $500,000. Here, the cap limited the recovery of a survivor “simply because others also suffered losses,” the court wrote.

In a larger context, “the greater the number of survivors and the more devastating their losses are, the less likely they are to be fully compensated for those losses,” the court said.

‘Alleged’ Crisis

The Florida Legislature attempted to justify the cap on noneconomic damages by claiming that “Florida is in the midst of a medical malpractice insurance crisis of unprecedented magnitude,” according to the court. The Legislature claimed that rising medical malpractice liability insurance premiums were causing physicians to leave Florida, retire early from the practice of medicine, or refuse to perform high-risk procedures, thereby limiting the availability of health care.

At the time, lawmakers relied upon a report prepared by the Governor’s Select Task Force on Healthcare Professional Liability Insurance.

But the court said the finding by the Legislature and the task force that Florida “was in the midst of a bona fide medical malpractice crisis, threatening the access of Floridians to health care, is dubious and questionable at the very best.”

The justices said they did not have to abide by that task force’s findings, which the court described as “not fully supported by available data” and actually “undermined by authoritative government reports.”

For example, the court cites a 2003 report by the U.S. General Accounting Office that found that from 1991 to 2001, the numbers of physicians in Florida were actually increasing, not decreasing.

The court questioned lawmakers’ analysis that excessive awards were partly to blame for the crisis, noting that a Florida Office of Insurance Regulation official testified he had found no evidence to suggest that there had been a large increase in the number of frivolous lawsuits filed in Florida, nor was there any evidence of excessive jury verdicts in the prior three years.

According to the court, even the task force itself was not sure there was a crisis. For example, the task force stated that it “believes” the alleged crisis “could get worse in the coming years.” The task force also said that insurance premiums “may become unaffordable, and/or coverage may become unavailable at any price to many physicians and hospitals.”

Further, the task force, despite blaming “actual and potential jury awards of noneconomic damages” for the crisis, recognized that there are other explanations for the dramatic rise in insurance premiums– including the typical insurance underwriting cycle, according to the court.

Moreover, there was no evidence that high malpractice premiums were why doctors who were leaving the state were doing so, according to the court.

“[A]lthough medical malpractice premiums in Florida were undoubtably high in 2003, we conclude the Legislature’s determination that ‘the increase in medical malpractice liability insurance rates is forcing physicians to practice medicine without professional liability insurance, to leave Florida, to not perform high-risk procedures, or to retire early from the practice of medicine’ is unsupported,” the high court opinion says.

Even if a “crisis” existed in 2003 when the statute enacted, that does not justify keeping the caps in place now. “[A] crisis is not a permanent condition. Conditions can change, which remove or negate the justification for a law, transforming what may have once been reasonable into arbitrary and irrational legislation.”

Finally, the court said, the leading companies selling medical malpractice insurance in Florida “are far from struggling financially.”


The Florida Medical Association predicted rising insurance costs could again drive doctors out of Florida because of this ruling.

“Thanks to the Florida Supreme Court, we can be sure that patients will face an intensified access to care crisis. The likely outcome will be that trial lawyers will refocus their sights on physicians, meritless lawsuits will clog our courts and physicians will move to states with a more favorable litigation climate,” Dr. Alan Harmon, the group’s president, said in a statement.

Debra Henley, executive director of the trial lawyers’ Florida Justice Association, said caps on damages are fundamentally unfair to the victims of medical negligence.

“When little kids lose their mommy or daddy because of medical malpractice, they’re absolutely victims,” she told The Associated Press.

The ruling doesn’t address caps in malpractice cases where the patient doesn’t die. Henley said she expects that aspect of the law will be before the court at some point.

While the ruling doesn’t address caps in malpractice cases where the patient doesn’t die, Henley told The Associated Press that she expects the court will eventually address that provision of the law.

Dissenting Opinion

Chief Justice Ricky Polston dissented, arguing that the court was disregarding the rational basis standard as well as the Legislature’s policy role under Florida’s constitution.

“The Legislature’s policy choice of enacting a cap of $1 million on noneconomic damages in medical malpractice cases involving death is rationally related to the legitimate state interest of decreasing medical malpractice insurance rates and increasing the affordability and availability of health care in Florida. Therefore, under our precedent, the cap does not violate Florida’s constitutional guarantee of equal protection,” Polston wrote.