Florida Supreme Court Holds Statutory Cap on Non-Economic Wrongful Death Damages in Medical Malpractice Actions Violates the Equal Protection Clause of the Florida Constitution

Mar 24, 2014   

In Estate of Michelle Evette McCall, et. al. v. United States of America, SC11-1148 (Fla. 2014), the Florida Supreme Court decided the following certified question:


Between 2005 and 2006, Michelle McCall received prenatal medical care at a U.S. Air Force clinic as an Air Force dependent.  She had a healthy and normal pregnancy until the last trimester.  On February 21, 2006, Ms. McCall’s medical condition required that labor be induced immediately. During delivery, Ms. McCall lost a significant amount of blood.  Following delivery, her blood pressure began to drop rapidly and remained dangerously low.  The attending physician never checked her vital signs and instead relied exclusively on inaccurate and/or incomplete information from the attending nurse. When the treating physician finished treating Ms. McCall, he ordered an immediate blood count and, if necessary a blood transfusion.  An hour after the physician’s order, a nurse presented to draw blood. The nurse found Ms. McCall unresponsive.  Ms. McCall never regained consciousness and subsequently passed away.

The Estate of Michelle E. McCall filed a lawsuit alleging medical malpractice against the United States of America under the Federal Tort Claims Act (“FTCA”).  In its simplest form, the FTCA constitutes a limited waiver of sovereign immunity and permits a private citizen to sue the United States in federal court for torts committed by persons acting on behalf of the United States.  See 28 U.S.C. §1346(b)

(…the district courts…shall have exclusive jurisdiction of civil actions on claims against the United State,, for money damages, accruing on and after January 1, 1945, for injury or loss of property, or personal injury or death caused by the negligent or wrongful act or omission of any employee of the Government while acting within the scope of his office or employment, under circumstances where the United States, if a private person, would be liable to the claimant in accordance with the law of the place where the act or omission occurred.).

The application of Florida Statute §766.118 (“Determination of noneconomic damages”) was triggered because FTCA “damages are determined by the law of the State where the tortious act was committed…, subject to the limitations that the United States shall not be liable for ‘interest prior to judgment or for punitive damages.’” Hatahley v. United States, 351 U.S. 173, 182 (1956).

Florida Statute §766.118 places a cap on noneconomic damages in personal injury claims arising out of medical malpractice.  For practitioners, noneconomic damages are limited to $500,000, unless the negligence results in a permanent vegetative state or death, in which case the total noneconomic damages are limited to $1,000,000.

At trial, the United States District Court for the Northern District of Florida determined that Petitioners’ economic damages totaled $980,462.40, while the noneconomic damages totaled $2,000,000 ($500,000 for Ms. McCall’s son and $750,000 for each of her parents).  Applying Fla. Stat. §766.118(2), the district court then limited the Petitioners’ recovery of wrongful death noneconomic damages to $1,000,000.

On appeal to the Eleventh Circuit, the Petitioners launched a constitutional challenge against Fla. Stat. §766.118(2) both on a state and federal level. While the Eleventh Circuit affirmed application of the statutory cap on noneconomic damages, it granted a motion filed by the Petitioners to certify four (4) questions to the Florida Supreme Court regarding Florida’s cap on noneconomic wrongful death damages in medical malpractice actions.  The Florida Supreme Court rephrased the first question as noted above and embarked on a constitutional analysis The court ultimately concluded that the remaining three (3) certified questions need not be addressed..

First, a brush up on the Equal Protection Clause.  Article I, Section 2 of the Florida Constitution states as follows:

Basic rights.—All natural persons, female and male alike, are equal before the law and have inalienable rights, among which are the right to enjoy and defend life and liberty, to pursue happiness, to be rewarded for industry, and to acquire, possess and protect property; except that the ownership, inheritance, disposition and possession of real property by aliens ineligible for citizenship may be regulated or prohibited by law. No person shall be deprived of any right because of race, religion, national origin, or physical disability.

In other words, “everyone is entitled to stand before the law on equal terms, with, to enjoy the same rights as belong to, and to bear the same burden as are imposed upon others in a like situation.”  Caldwall v. Mann, 26 So. 2d 788, 790 (Fla. 1946).

Next, the Court moved its analysis towards the rational basis test. In order to satisfy the rational basis test, a statute must “bear a rational and reasonable relationship to a legitimate state objective, and it cannot be arbitrary or capriciously imposed.”  Dep’t of Corr. v. Florida Nurses Ass’n, 508 So. 2d 317, 319 (Fla. 1987).

Ultimately, the Florida Supreme Court held that the “cap on wrongful death noneconomic damages provided in section 766.118, Florida Statute, violates the Equal Protection Clause of the Florida Constitution.”

In reaching its conclusion, the Court engaged in a detailed analysis of the alleged facts and circumstances which warranted implementation of Fla. Stat. §766.118, namely, the alleged medical malpractice insurance crisis in Florida.  The Court found that the so-called “crisis” was not, in fact, a crisis and that the alleged facts supporting such a crisis were either readily contradicted or questionable, at best. The Court stated that the available evidence failed to establish a rational relationship between a cap on noneconomic damages and the alleviation of the purported crisis.  In other words, the rational basis test had not been satisfied.  Instead, the Court noted that the cap on noneconomic damages served no purpose other than to arbitrarily punish the most grievously injured or their surviving family members.  The result:  Fla. Stat. 766.118 has now been ruled unconstitutional.

Health care providers must remain knowledgeable of the ever-changing landscape of laws and regulations affecting the field of medicine.  Fuerst Ittleman David and Joseph, P.L. has extensive experience not only defending health care providers in negligence lawsuits, but also keeping them apprised of such changes in the law.  If we can be of assistance to you, email us at contact@fidjlaw.com  or call 305.350.5690.