Academic journal article Missouri Law Review

Missouri's Statutory Cause of Action for Medical Negligence: Legitimate Application of Legislative Authority or Violation of Constitutional Rights?

Academic journal article Missouri Law Review

Missouri's Statutory Cause of Action for Medical Negligence: Legitimate Application of Legislative Authority or Violation of Constitutional Rights?

Article excerpt


For hundreds of years, victims of medical malpractice have been authorized to file civil actions against negligent health care providers. (1) Missouri affirmed the presence of a medical negligence cause of action when the legislature adopted the common law practices of seventeenth-century England under Missouri Revised Statutes section 1.010 in 1825. (2) A right to trial by jury accompanied the cause of action and included the right to receive a damages award in accordance with a jury determination. (3)

In 1986, Missouri Revised Statutes section 538.210 capped noneconomic portions of jury awards in medical negligence cases at [Dollar]350,000. (4) The plaintiff in Adams v. Children's Mercy Hospital, a 1992 case, was first to challenge the statute on constitutional grounds. Section 538.210 survived, however; the Supreme Court of Missouri determined the fact-finding role of a jury remains uncompromised even when judges alter the awards. (5)

When caps were tested again in Watts v. Lester E. Cox Medical Centers, in 2012, the Supreme Court of Missouri took a different approach and ruled that noneconomic damages limitations did interfere with the right to trial by jury. (6) The court reasoned that imposing a cap on jury awards, when the cap would not have applied to identical causes of action in 1820, amounted to an unconstitutional alteration of the right to trial by jury. (7) The Missouri General Assembly responded by enacting Senate Bill 239 ("SB 239"), which attaches noneconomic damages caps to a new statutory cause of action for medical negligence. (8)

This Note discusses whether SB 239 is likely to survive future arguments against its constitutionality. Part II describes the bases upon which damages caps have been challenged in Missouri and the role of the right to trial by jury in analyzing damages caps. Part III then provides a short procedural history of SB 239. Finally, Part IV discusses whether SB 239 attempts to alter a common law cause of action in a way that renders the statute unconstitutional, or whether it abolishes and recreates the cause of action in a manner permitted by the Missouri Constitution.


Whether to limit the value of noneconomic damages recoverable by victims of medical negligence is a contentious issue and one Missouri courts and lawmakers have struggled to manage. (9) Such caps were first instituted in Missouri in 1986, after more than 150 years of practice without them. (10) In 2012, the law was overturned for constitutional reasons, but it recently returned in a slightly new form. (11) Under SB 239, medical malpractice--traditionally a common law tort (12)--became a statutory cause of action and is again accompanied by limitations on noneconomic damages. (13) This Part examines more closely the path leading to a statutory cause of action, including the origins of medical malpractice claims in Missouri and the cases related to caps on noneconomic damages.

A. Overview of Damages, Caps on Damages

As civil tort suits, today's medical malpractice claims allow awards of both compensatory and punitive damages. (14) Compensatory damages are categorized as economic damages--financial charges resulting from the injury, including lost wages and medical expenses--or noneconomic damages--intangible costs of the injury, such as physical impairment or the experience of pain. (15) Noneconomic damages are commonly considered compensation for "pain and suffering," though the scope of these awards reaches far beyond the physical experience of pain. (16)

Medical malpractice lawsuits are unique among civil claims for the frequency with which states ascribe to them noneconomic damages caps. (17) At least thirty-seven states have at some time imposed limits on the amount of money that may be awarded to victims of medical negligence. (18) Such limitations first began appearing in the early 1970s, when the limited availability of medical malpractice insurance led to dramatically increased costs. …

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