The Florida Supreme Court decision on NICA and how it may affect the anticipated ruling on medical malpractice caps


Written by Justin C. Leto


Medical Malpratice lawyers, hospitals, doctors and insurers are eagerly awaiting the Florida Supreme Court decision in the case of McCall v. United States.  In that case, the Court has been asked to decide whether Florida’s caps on pain and suffering damages are unconstitutional.  Presently, Florida Statute section 768.118 sets forth the maximum amount of money an injured plaintiff and their family may receive for pain and suffering following a medical malpractice incident.  In McCall, the Court has been asked to review the statute to determine whether it is constitutional or whether Florida’s caps on damages should be eliminated.


The Court has not yet issued its opinion, but a recent opinion from the Court may signify how the Court will ultimately decide the issue.  The case is Samples v. Florida Birth Related Neurological Injury Compensation AssociationAs a brief background, Florida has established a system to compensate children who suffer neurological injuries during the birthing process.  If a child suffers a brain injury or other neurological injury during birth, the child and their family cannot sue the doctor or hospital.  Instead, the family is limited to recovery under the Neurological Injury Compensation Association, known as NICA.  NICA is a state run association that provides compensation to victims of birth related injuries regardless of whether the doctor or hospital is at fault for the injuries.  In establishing NICA, the Florida Legislature decided that it was best to provide a no-fault system of compensation for injured babies instead of allowing the children and their families to utilize the civil justice system to seek compensation.


Under NICA, the child is provided money over time for care and treatment of the birth relates injury.  Further, NICA provides the parents with $100,000 as a maximum compensation for their pain and suffering.  The statute provides that the award of $100,000 is a maximum, regardless of whether there is one or two parents.


In the Samples v NICA case, the parents of a brain injured child challenged the constitutionality of the statute because it provides unfair and unequal compensation to families with two parents versus families with only one parent.  Under the sensible analysis set forth by the Samples, if there is a one-parent home, that one parent recieves $100,000 for their pain and suffering.  However, if there are two parents, and the parents are divorced, each parent is limited to $50,000 (or whatever apportionment the Administrative Law Judge deems appropriate).  This, in the Samples view, is a violation of the Equal Protection Clause of the Constitution.


In analyzing this case, the Florida Supreme Court reviewed the reasoning of the 5th District Court of Appeals in holding that the statute was constitutional.  The Florida Supreme Court identified all of the reasons why the 5th District found the NICA statute constitutional, as follows:


“The Fifth District then denied each of the Samples’ constitutional claims, holding that the parental award provision: (1) does not cause disparate treatment among similarly situated persons and—even assuming discrimination did exist—is rationally related to the State’s legitimate interest in maintaining the actuarial soundness of the Plan, id. at 25-26; (2) “is sufficiently clear in its intent to provide no-fault economic compensation to parents” and thus allows for an award to be split—if at all—”based on articulable economic reasons supported by detailed factual findings,” id. at 28; and (3) “provides both a reasonable alternative remedy and a commensurate benefit” to the Samples’ right of access to courts and is the only method of meeting the overpowering public necessity of ending the medical malpractice crisis.”


Ultimately, after a lengthy analysis, the Florida Supreme Court affirmed the decision of the 5th District and held that the monetary limitation for parental pain and suffering is constitutional.  But, it is the reasoning behind this holding that may give us a preview of how the medical malpractice caps on damages will be decided in the McCall case.


In Samples, the Court was certain to distinguish the NICA cases from other types of medical malpractice cases because of two factors: (1) NICA is a state run compensation association that relies on acturial soundness in order to successfully compensate children injured at birth, and (2) NICA is a no fault system, meaning there is never a determination that malpractice has occurred.  Instead, if you are injured at birth and qualify under all other NICA factors, NICA applies regardless of fault.


The key issue for the Court to decide was whether the limitations in NICA were rationally related to a state interest.  In the past, whenever the Courts have held that a malpractice limitation on damages was constitutional, the “rational basis” has been the existence of a “medical malpractice crisis” which needed to be fixed.  Although the studies all conclude that there is no “malpractice crisis” in Florida, this remains the key basis cited by Florida courts in holding that caps on damages are rationally related to a state interest. That is what makes the Samples case so intriguing.


As is shown in the quote above, the lower appellate court found the “malpractice crisis” to be a rational basis to find NICA’s caps constitutional.  But the Florida Supreme Court never addressed this basis.  Instead, the Florida Supreme Court held that NICA’s damage caps were rationally related to the legitimate state interest of providing an actuarial sound system for compensating neurologically injured children.  The fact that the Court was completely silent as to whether there is a “malpractice crisis” leads me to believe the Court rejects this reasoning.  In fact, one of the major points of contention in the oral argument in the McCall case was whether such a “malpractice crisis” even existed at all.  Proponents of the caps (insurance companies, doctors and hospitals) all argued that the “malpractice crisis” is prevalent and detrimental to Florida.  However, challengers of the caps (victims of medical negligence, advocacy groups, the Florida Justice Association) all presented actual data which showed that no such “malpractice crisis” existed and that it was all a farse created to deprive injured people from fair compensation.


While there is no way to predict with any certainty what the Florida Supreme Court will do with the medical malpractice caps, their silence on the medical malpractice crisis gives me hope that they will ultimately hold that caps on medical malpractice damages are unconstitutional.

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