On July 1, 2015, the Fourth District Court of Appeals (Fourth DCA) issued a major decision affecting medical malpractice cases in Florida. In the case North Broward Hospital District v. Kalitan, the court held that the caps on non-economic damages in personal injury medical malpractice cases were unconstitutional. In its opinion, the Fourth DCA extended the Florida Supreme Court’s logic in Estate of McCall v. United States to personal injury caps. 

In Kalitan, the plaintiff underwent outpatient surgery to treat carpal tunnel syndrome in her wrist. During intubation, as part of the administration of anesthesia for the surgery, one of the tubes perforated plaintiff’s esophagus.  When plaintiff awoke after surgery, she complained of excruciating pain in her chest and back. The anesthesiologist, unaware of the perforated esophagus, ordered administration of a drug for chest pain and concluded there was no issue with plaintiff’s heart. Plaintiff was released from the hospital. However, the next day a neighbor found her at home unresponsive. She was rushed back to the hospital for life-saving surgery. Plaintiff spent several weeks in a drug-induced coma before having additional surgeries and intensive therapy. 

At trial, the jury awarded plaintiff $4 million in non-economic damages, which were reduced by the trial court post-verdict to $2 million under the non-economic damages caps found in section 766.118, Florida Statutes. Plaintiff appealed the reduction of her jury-award. 

Judge Forst delivered the opinion for the Fourth DCA. The opinion analyzed the various opinions in McCall, which determined that the cap on non-economic damages in wrongful death cases violated equal protection. Finding that McCall applied retroactively, the court held that the medical malpractice personal injury non-economic damages caps violated equal protection. The court found that under the medical malpractice personal injury non-economic damages caps, those victims of malpractice who have the most lucrative cases due to perilous injuries are unable to recover the full amount of their damages while those who suffered less harm are able to. 

The court stated that because the caps did not implicate either a suspect class or fundamental right, the rational basis test applied to discern the caps’ constitutionality. To maintain constitutionality under 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.” Relying on McCall, the court reasoned that that there was no rational basis to limit non-economic damages in personal injury cases. The court found that the legislative impetus for the damage caps, an alleged medical malpractice “insurance crisis”, no longer existed. Furthermore, the court found that there was no rational correlation between caps on non-economic damages and lower malpractice insurance rates. The Fourth DCA held that section 766.118, Florida Statutes, lacked any rational relation to a state objective, and fails both the “smell test” as well as the rational basis test. It is unknown at this point whether or not the defense will appeal this case to the Florida Supreme Court.  

In sum, this is another blow to the medical malpractice caps in Florida. This decision is controlling in the 4th DCA at this time and it's expected that other DCA's will find it persuasive.  It is unclear how this decision will affect the 2011 Medicaid caps, which were passed by the Florida legislature as part of a later unrelated Medicaid overall. Health care providers should review and discuss their malpractice coverage with their insurers, brokers, or legal counsel.