A Florida appeals court July 1 held that caps on noneconomic damages awards in medical malpractice actions imposed by state law violated the equal protection clause of the Florida Constitution.

According to the court’s analysis, the statute fails to provide equal protection under the law because those individuals with noneconomic damages in an amount that falls below the caps would be fully compensated under Florida Statutes section 766.118, but injured parties with noneconomic damages in excess of the caps are not fully compensated.

The plaintiff in the case, Susan Kalitan, underwent surgery in 2007 at North Broward Hospital District to treat carpal tunnel syndrome in her wrist. During intubation for administration of anesthesia for the surgery, one of the tubes perforated plaintiff’s esophagus.

Plaintiff was later discharged from the hospital that afternoon without anyone being aware of the perforated esophagus. At home, plaintiff became unresponsive and was rushed to the emergency room of a nearby hospital where she had life-saving surgery to repair her esophagus.

According to the opinion, plaintiff remained in a drug-induced coma for several weeks and continues to suffer from pain throughout the upper half of her body and from serious mental disorders as a result of the traumatic incident.

Plaintiff filed a medical negligence action against the medical center, several of the physicians and nurses present at the surgery, and others (collectively defendants). Among the issues litigated at trial were personal liability and vicarious liability, as well as the extent of the injuries, and whether they amounted to “catastrophic injury” under Florida law.

The jury ultimately found in plaintiff’s favor, determining, among other findings, that plaintiff suffered catastrophic injury. The jury awarded plaintiff $4,718,011 in total damages, with noneconomic damage awards of $2 million for past pain and suffering and $2 million for future pain and suffering.

Multiple post-trial motions were filed and the court limited the noneconomic damage awards by the caps provided in section 766.118 after applying an increased cap for the finding of catastrophic injury. As a result, the noneconomic damages award of $4 million was reduced by close to $2 million.

Plaintiff appealed the application of the caps, among other issues. The Florida District Court of Appeal, Fourth District, agreed that the caps were unconstitutional as applied to medical malpractice actions.

In Estate of McCall v. United States, 134 So. 3d 894 (Fla. 2014), the Florida Supreme Court determined that the caps on noneconomic damages awards in section 766.118 violated the equal protection clause of the Florida Constitution as applied to wrongful death cases.

Although McCall specifically addressed only wrongful death actions, the appeals court said its reasoning applies to both personal injury and wrongful death actions.

In McCall, a plurality of justices concluded that the medical malpractice “crisis,” which the caps were enacted to address, no longer existed and, consequently, there is no justification for “the arbitrary reduction of survivors' noneconomic damages in wrongful death cases based on the number of survivors . . . without any commensurate benefit to the survivors and without a rational relationship to the goal of reducing medical malpractice premiums.”

The appeals court rejected defendants’ attempt to distinguish single claimant personal injury cases from the multiple claimant wrongful death action addressed in McCall, finding “no basis to do so that would not conflict with the reasoning of the Florida Supreme Court’s plurality and concurring opinions, which strike at the underpinning of the Legislature’s caps on noneconomic damages in general.”

As long as the caps “discriminate between classes of medical malpractice victims, as they do in the personal injury context they are rendered unconstitutional by McCall, notwithstanding the Legislature’s intentions,” the appeals court held.

Accordingly, the appeals court directed the trial court to reinstate the total damages award as found by the jury, noting, however, that the damages may still be limited by the doctrine of sovereign immunity.

North Broward Hosp. Dist. v. Kalitan, Nos. 4D11-4806, 4D11-4833, and 4D11-4834 (Fla. Dist. Ct. App. July 1, 2015).