Missouri’s 2015 Statutory Non-economic Damages Cap for Med Mal Claims Constitutional; time of trial, not date cause of action accrues, dictates the applicable damages cap.

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On July 22, 2021, the Missouri Supreme Court decided a medical malpractice case involving a constitutional challenge to the statutory cap on non-economic damages, codified at Mo. Rev. Stat. § 538.210 (2015), which also abolished the common law cause of action for medical negligence.

The primary issue in Velazquez v. University Physician Associates, et al., No. 98977 was whether the non-economic damages caps contained in § 538.210 violated Article I, § 22(a) of the Missouri Constitution.  In other words, did the Missouri legislature have the power to repeal the long-standing common law cause of action for medical negligence and replace it with a newly created statutory cause of action that included a damages cap?

At trial, Plaintiff Ordinola Velazquez (“Ordinola”) won a jury verdict against several healthcare providers and was awarded damages for injuries she allegedly sustained during the delivery of a child and post-partum care in September 2015.  The jury allocated 100% of fault to the physicians and awarded Ordinola $30,000 in past economic damages (including past medical expenses), $300,000 in past non-economic damages, and $700,000 in future non-economic damages.  After various post-trial motions, the court concluded that Ordinola’s injuries involved “catastrophic personal injuries” in accordance with § 538.210.2(2) and reduced the non-economic damages awarded to her by the jury to $748,828 (the amount of the catastrophic personal injury cap at the time of the jury verdict).  Ordinola appealed, arguing that § 538.210’s non-economic damages caps are unconstitutional under article I, § 22(a) of the Missouri Constitution.

In Velazquez, the Court analyzed two precedential cases:  Watts v. Lester E. Cox Medical Centers, 376 S.W.3d 633 (Mo. banc 2012) (holding the damages cap in the earlier version of Section 538.210 was an unconstitutional infringement on the right to jury trial which attached to the plaintiff’s common law claim for medical negligence), or Sanders v. Ahmed, 364 S.W.3d 542 (Mo. banc 2016) (holding that damages caps in statutorily created causes of action are constitutional because the Missouri legislature has the right to negate both a cause of action and a remedy that did not exist prior to the ratification of Missouri’s constitution in 1820).  The Court reasoned that because Watts was decided under the old version of § 538.210, it did not control; rather, Sanders controlled.

The Court noted that medical negligence actions were common law claims until the General Assembly amended § 538.210 to provide, in relevant part: “A statutory cause of action for damages against a health care provider . . . is hereby created, replacing any such common law cause of action.”  The Velazquez Court, citing Kilmer v. Mun, 17 S.W.3d 545, 550 (Mo. banc 2000), noted that it is undisputed that the General Assembly has the power to abolish common law causes of action.

Thus, because the statutory amendment in 2015 converted a medical negligence claim from a common law to a statutorily created cause of action, the General Assembly had the legislative authority to enact statutory non-economic damage caps.  As such, the Court held that § 538.210’s non-economic damages caps did not violate article I, § 22(a) of the Missouri Constitution.

A related issue discussed by the Velazquez Court was whether it should apply the statutory cap on non-economic damages in effect in 2019 or rather the cap in effect in 2015. § 538.210.2 caps non-economic damages for catastrophic injuries at $700,000 and § 538.210.8 explicitly provides for an annual inflation adjustment to the caps at 1.7 percent on “an annual basis effective January first each year.”  As such, the court noted that § 538.210.8 unambiguously expresses the legislative intent that a plaintiff’s non-economic damages award be protected from inflation.  Therefore, the court in Velazquez concluded that § 538.210.8 applies at the time of trial, not to the time at which the malpractice occurred.

Ultimately, in Velazquez, the Missouri Supreme Court upheld the non-economic damages caps contained in § 538.210 in their entirety and concluded § 538.210.8 applies only prospectively to damages awarded on or after its effective date.

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