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California's top court to address med-mal cap issue

California voters who went to the polls on the matter in November might not have the final say on whether that state's cap on medical malpractice damages should remain at $250,000.

The California Supreme Court announced last Wednesday that it will hear Hughes v. Pham, a case that challenges the constitutionality of the state's Medical Injury Compensation Reform Act of 1975, known as MICRA, which caps pain and suffering, or noneconomic damages, at $250,000. The case also looks at how noneconomic damages should be paid. The court agreed to hold the case until after it hears another, Rashidi v. Moser, addressing several tangential issues.

California voters in November rejected Proposition 46, which would have raised that cap to $1.1 million and indexed it to inflation. The vote followed a heated battle between those for and against the proposition.

Proponents of the proposition argued the cap doesn't fairly compensate injured individuals who may not be eligible for economic damages because they don't work, such as children and stay-at-home parents. Opponents, however, said raising the cap would mean more lawsuits, leading to higher medical malpractice insurance premiums for doctors and higher costs for patients.

Consumer Watchdog, which urged voters to pass Prop. 46 this year, cheered the California Supreme Court's decision to hear the case Wednesday.

“Several states in recent years have determined that their own damages caps were unconstitutional and unjust—it's time for California to join them,” Pam Pressley, litigation director for Consumer Watchdog, said in a statement. “Families who have lost loved ones and victims of medical negligence deserve the justice and accountability that the damages cap denies.”

Pressley had written an amicus letter to the court Nov. 18 asking it take the case.

But Kenny Pedroza, a lawyer for the defendant in the case, said he doesn't believe the state's highest court will examine the constitutionality of the caps. Rather, the court will look only at the issue of how the noneconomic damages should be paid, said Pedroza, of the firm Cole Pedroza in San Marino, Calif. Specifically, the case addresses the question of whether noneconomic damages awarded by a court should be offset by dollars awarded through previous settlements.

Pedroza said he believes the court will hear Rashidi v. Moser and then send the case back to the appeals court to reconsider the issue of the offset in light of whatever opinion is reached in Rashidi v. Moser.

Those on the other side, however, say they're hopeful the court will look at the constitutionality of the cap. “Now that Prop. 46 has been defeated there may be more reason for the court to take the constitutional issues up in this case,” said Valerie Nannery, a lawyer for the plaintiffs with the Center for Constitutional Litigation in Washington.

In Hughes v. Pham, Trent and Lisa Hughes allege that neurosurgeon Christopher Pham's delay in treating Trent Hughes after an off-road vehicle accident led Trent Hughes to become a paraplegic with no bladder, bowel or sexual function. A jury determined that Trent Hughes suffered $2.75 million in noneconomic damages, but that amount was then reduced to $250,000 per MICRA.

The plaintiffs argue that the cap violates constitutional guarantees of equal protection, the right to a jury trial and separation of powers. They argue that the cap “arbitrarily and irrationally singles out the most severely injured victims of medical malpractice for unfavorable treatment,” according to court documents.

Pham, however, argues that there was “insufficient evidence to establish causation,” that the trial court wrongly excluded important evidence and that the award for future medical care costs wasn't justified by the evidence, among other contentions, according to court documents.

A California appeals court in September upheld the judgment of the trial court, ruling against the Hughes in all matters except the structure of the judgment, which the appeals court remanded for further proceedings.

Molly Weedn, a spokeswoman for the California Medical Association, which filed a friend-of-the-court brief in support of MICRA's constitutionality in the case, said in an e-mail that "Time and time again, the courts have upheld the constitutionality of the Medical Injury Compensation Reform Act's (MICRA) cap on non-economic damages, including in the case of Hughes v. Pham. Consumer Watchdog is looking to gain attention on an issue the courts and voters have clearly and definitively opposed. In this instance. The Supreme Court is reviewing an issue involving settlements in MICRA cases, but has not agreed to review MICRA's constitutionality.”

Follow Lisa Schencker on Twitter: @lschencker


Lisa Schencker

Lisa Schencker covers legal issues and enforcement agencies. Before joining Modern Healthcare in 2014, she was an education reporter for the Salt Lake Tribune and before that wrote for the Bakersfield Californian and the Scranton (Pa.) Times-Tribune. She has bachelor’s and master’s degrees in journalism from the University of Illinois at Urbana-Champaign.

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