Louisiana Supreme Court Affirms Constitutionality of the Medical Malpractice Cap on Damages for the First time in Nearly 20 Years
Louisiana enacted the Medical Malpractice Act (“MMA”) in 1975 to address a growing crisis in the healthcare industry: the sharply rising cost of medical malpractice insurance. One of the Act’s primary methods to curtail those rising costs is a limit on the amount of damages awardable to a medical malpractice claimant. Specifically, the MMA provides that “[t]he total amount recoverable for all malpractice claims for injuries to or death of a patient, exclusive of future medical care and related benefits as provided in R.S. 40:1299.43, shall not exceed five hundred thousand dollars plus interest and costs.” La. R.S. 40:1299.42(B). In March, for the first time in nearly twenty years, the Louisiana Supreme Court re-examined the constitutionality of the cap, holding that it does not violate the constitution. In Oliver v. Magnolia Clinic, the Court released its lengthy, detailed analysis. After trial, the jury returned a verdict for the Olivers that included over $6 million in general damages, along with past and future medical expenses. Applying the MMA damages cap, the trial court reduced the general damages award to $500,000. On appeal, a majority of the Third Circuit Court of Appeal reversed the trial court’s reduction of general damages, reinstated the jury’s original award, and held that the cap violated the equal protection and adequate remedy provisions of the Louisiana Constitution.
The Louisiana Supreme Court reversed, maintaining the constitutionality of the $500,000 cap, and reinstating the trial court’s reduction of the jury award. In so doing, the Court reiterated and reaffirmed its 1992 opinion in Butler v. Flint Goodrich Hospital of Dillard University, where it endorsed the legislature’s justification for the cap: “limiting damages in malpractice cases lowers insurance costs, thereby assuring accessible and affordable healthcare for the public.” Both the Butler Court and the Oliver Court pointed to three benefits medical malpractice plaintiffs enjoy as a result of the law despite the cap: “(1) [a] greater likelihood that the offending physician or other health care provider has malpractice insurance; (2) [a] greater assurance of collection from a solvent fund; and (3) payment of all medical care and related benefits.” Thus, the Court held, “[t]he discrimination inherent in the cap is offset by this ‘alternative remedy.’”
After citing these general goals, the Court in Oliver confirmed the constitutionality of the Act by reiterating the purpose of the cap itself:
This “quid pro quo” acknowledged in Butler is just as constitutionally sound today as it was when we addressed it in 1992 insofar as the same objective exists now as at the time of the legislation’s inception in 1975; i.e., the legislature acted to combat the rising insurance premiums in an inherently risky industry in order to avoid a healthcare crisis in this state. Both now and then, malpractice claims exceeding the cap’s monetary limit would effectively increase the probability that health care providers would not have medical malpractice insurance sufficient to pay for these uncapped damages. The result would be an underfunded, perhaps insolvent system of recovery for malpractice victims. Any discrimination resulting from the cap, while unfortunate, substantially furthers a legitimate state interest, making the “imperfect balance” “reasonable.”
But often malpractice plaintiffs don’t simply attack the existence of a cap. They also criticize the dollar amount of the cap, claiming it to be woefully inadequate to compensate major losses medical malpractice causes. Such was the case in Oliver, prompting the Court to take its analysis one step further than it had it Butler. This Court addressed the “perceived under-compensation in which an untouched damages cap results or could result,” holding that:
The effects of inflation and economic changes touch on the adequacy of the cap’s amount, rather than its constitutionality. Our job, as a court tasked with reviewing laws, is to ensure statutes are free of constitutional infirmities. Once satisfied that legislation does not infringe upon constitutional rights, any other perceived infirmity is to be addressed by the legislature.
Nevertheless, legislative efforts to increase the cap rarely garner much support. For example, The 2012 Regular Legislative Session saw an effort to increase the amount of recovery from $500,000 to $750,000, and also make it exclusive of economic losses, including loss of earnings and loss of earning capacity (See Louisiana House Bill 105 (2012)). But the bill never made it out of committee. Prior legislative sessions have seen similar bills achieve similar results.
The Court appears as willing as ever to preserve the constitutionality of the damages cap provided by the MMA. Even more recently, in an opinion just released on May 22, 2012, the Court relied on Oliver to reverse a lower court’s finding that the MMA is unconstitutional. See Arrington v. Galen-Med, Inc., 2012-908 (La. 5/22/12), ___ So.3d ___.This marks twice in the last four months that the Court has confirmed the MMA’s constitutionality.
Providers can sleep well at night knowing the MMA damages cap is solid as it has ever been. Although the Louisiana Supreme Court has remained relatively quiet on the issue for more than twenty years, two cases released in the first half of 2012 demonstrate its continued ratification of the damages cap. The Court seems unwilling to entertain any argument claiming the amount of the damages cap to be insufficient or inadequate, instead entrusting the legislature with the responsibility to cure any infirmities with the law since, as a whole, the Act passes constitutional muster. Bottom line: unless we see a major shift in the makeup and ideology of the Louisiana Supreme Court or Louisiana legislature, healthcare providers will remain protected by the $500,000 damages cap.
 2011-2132(La. 3/13/12), ___ So.3d ___.
 607 So.2d 517 (La. 1992), cert denied, 508 U.S. 909 (1993).
 Of note, the Court in Oliver also confirmed that nurse practitioners are now, and always have been, included in the statute’s definition of “health care provider” and are entitled to the full benefits provided by the Act.