Until a few days ago in the state of Missouri, non-economic damages (pain and suffering) were capped at $350,000. That all changed recently when the Missouri Supreme Court declared the cap unconstitutional - changing the medical negligence landscape.

On July 31, 2012, the Missouri Supreme Court handed down its decision in Watts, et al. v. Lester E. Cox Medical Centers, et al., No. SC91867. In this important ruling, the Court overturned the non-economic statutory damages cap in medical negligence actions in a 4-3 decision. The Missouri non-economic damage cap limits a plaintiff's recovery of damages for items such as pain and suffering. For many years, this type of recovery was capped by statute so there could be no recovery greater than $350,000.00. A copy of the Court's opinion is here and a brief overview of the decision follows.

Plaintiff filed this medical malpractice action alleging that her son was born with disabling brain injuries due to negligent healthcare services provided by Defendants - Cox Medical Center and its associated physicians. The jury returned a verdict in favor of Plaintiff and awarded economic damages and $1.45 million in non-economic damages. The trial court entered a judgment reducing Plaintiff's non-economic damages to $350,000, as required by Missouri's statutory non-economic damages cap - § 538.210 RSMo.

The Supreme Court held that § 538.210 is unconstitutional to the extent it infringes on a jury's constitutionally-defined purpose of determining the amount of damages sustained by an injured party. In doing so, the Court overturned well-established, twenty-year-old precedent in Adams by and through Adams v. Children's Mercy Hosp., 832 S.W.2d 898, 907 (Mo.banc. 1992). The Court wrote that originally, before adoption of Missouri's state constitution, there was no common law limitation on a jury's ability to calculate damages. And when Article I, Section 22(a) of the Missouri Constitution was adopted almost 200 years ago, no limits existed on damage recovery. Consequently, any statutory scheme intended to limit a jury's ability to calculate damages, including a requirement that a trial court reduce them, violates a plaintiff's right to a trial by jury.

The language in the Missouri Constitution critical to the Court's holding was the "inviolate" right to a trial by jury in civil actions for personal injury. The Court emphasized that "the plaintiff has the full benefit of that right free from the reach of "hostile legislation" such as § 538.210 RSMo. The Court also noted that its decision finds support in the decisions of other states' courts - Washington, Oregon, Alabama, and Florida - that interpreted similar statutory cap language with respect to similar constitutional language.

The three dissenting judges were very critical of the majority for failing to respect stare decisis – i.e., the Court's "well-reasoned, long-standing precedent" in the Adams case. Like the majority, the dissenting justices identified state courts - Nebraska, Idaho, Ohio, and Maryland - that upheld similar statutory caps in the face of similar constitutional language.

Because of this new decision, non-economic damages are no longer statutorily capped in medical negligence matters in Missouri. But a recent opinion of the Court upheld statutory non-economic damages caps in wrongful death actions, which the Court reasoned are creatures of statute rather than common law. The immediate impact of the Watts decision likely will be to cause malpractice insurers and their insureds to be exposed to larger settlement demands, larger settlements, and larger actual verdicts.