Missouri high court upholds damages cap, but another challenge remains

Doctors are concerned that a ruling against the state’s noneconomic award limit could lead to more frivolous lawsuits against physicians.

By — Posted May 11, 2012

Print  |   Email  |   Respond  |   Reprints  |   Like Facebook  |   Share Twitter  |   Tweet Linkedin

After winning a recent lawsuit challenging the state’s noneconomic damages cap, Missouri doctors continue to fight another battle threatening to overturn the recovery limit.

The Supreme Court of Missouri ruled April 3 in Sanders v. Ahmed that the state’s noneconomic damages cap for medical liability cases was constitutional. The cap, adopted in 1986, impacts cases in which the alleged negligence happened before 2005. The limit was enacted at $350,000 but is now at more than $600,000 due to inflation.

The second suit, which the state high court has yet to decide, centers on Missouri’s latest $350,000 award limit. The cap impacts all medical liability lawsuits starting in 2005. A decision in the case,Watts v. Cox, is expected by the summer, said attorneys involved in the case.

The court’s analysis of Sanders could benefit physicians’ position in the Watts case that the cap should stand, said Jeffrey Howell, legal counsel for the Missouri State Medical Assn. “Precedent is on our side, [but] there’s a couple small differences [between the cases]. We can never tell” what the court is going to do, he said.

In Sanders v. Ahmed, a patient’s family said the cap used to reduce their jury award from $9.2 million to $1.2 million violated the Missouri Constitution.

The family had filed a wrongful death claim on behalf of Paulette Sanders, who died in 2005. Relatives claimed neurologist Iftekhar Ahmed, MD, failed to recognize and treat a fatal side effect resulting from a medication he prescribed to Sanders. Dr. Ahmed denied wrongdoing.

After winning at trial, the family filed a motion fighting the award reduction. A trial court upheld the reduction, and the family appealed. In their opinion, Supreme Court justices said the Legislature has the authority to enact damages caps (link).

“The remedy available in a statutorily created cause of action is a matter of law, not fact, and not within the purview of the jury,” the court said. “To hold otherwise would be to tell the Legislature it could not legislate; it could neither create nor negate causes of action and in doing so could not prescribe the measure of damages for the same. This court never has so held and declines to do so now.”

The ruling is a blow to plaintiffs’ rights, said William McIntosh, an attorney for the Sanders family.

“A jury is supposed to be able to decide your damages,” he said. “That’s why you have the Seventh Amendment of the Constitution. The courts have turned a blind eye to the Seventh Amendment.”

State has two damages caps

Timothy Alyward, an attorney for Dr. Ahmed, said he was relieved by the Sanders decision but not surprised, since other courts have upheld the cap. He noted, however, that the ruling applies only to older claims.

The Sanders ruling “will certainly have an impact on wrongful death cases where the cap can be applied,” Alyward said. But the pending ruling “will have a far, wide-reaching effect on all cases going forward.”

In Watts v. Cox, Deborah Watts sued Springfield Mo.-based Cox Medical Center and several physicians for negligence after her baby was born with brain damage in 2006. A jury awarded $1.4 million in damages, which was reduced to $350,000.

Watts fought the reduction, which was upheld by the trial court. The state Supreme Court heard arguments on March 27.

The Litigation Center for the American Medical Association and the State Medical Societies, along with the MSMA, filed a joint brief in the Watts case supporting the cap. (The Litigation Center was not involved in the Sanders case.)

In its brief, the Litigation Center said the state high court has “repeatedly and unanimously held that reasonable limits on common law rights are within the discretion of the Legislature and plainly falls within that discretion.”

If the cap is struck down, Missouri physicians will see higher insurance premiums and more frivolous lawsuits, said Howell, of the MSMA.

At least four other states await court decisions on the fate of their caps. The Indiana Supreme Court heard oral arguments May 3 in a case challenging the state’s total damages cap. In that case, a patient is contesting a jury award reduction of $8.5 million to $1.25 million, the limit for total damages in medical liability cases.

Florida, Michigan and Mississippi also have cases pending on their caps.

Back to top


Case at a glance

Is a noneconomic damages cap for wrongful death cases in Missouri constitutional?

The Supreme Court of Missouri said yes. The court said the Legislature had the authority to enact the 1986 cap. The ruling upholds a jury award reduction from $9.2 million to $1.2 million.

Impact: The ruling applies to all wrongful death cases in which the alleged negligence occurred before 2005. After 2005, Missouri’s noneconomic damages cap of $350,000 applies.

Ronald Sanders v. Iftekhar Ahmed, MD, Supreme Court of Missouri, April 3 (link)

Back to top



Read story

Confronting bias against obese patients

Medical educators are starting to raise awareness about how weight-related stigma can impair patient-physician communication and the treatment of obesity. Read story

Read story


American Medical News is ceasing publication after 55 years of serving physicians by keeping them informed of their rapidly changing profession. Read story

Read story

Policing medical practice employees after work

Doctors can try to regulate staff actions outside the office, but they must watch what they try to stamp out and how they do it. Read story

Read story

Diabetes prevention: Set on a course for lifestyle change

The YMCA's evidence-based program is helping prediabetic patients eat right, get active and lose weight. Read story

Read story

Medicaid's muddled preventive care picture

The health system reform law promises no-cost coverage of a lengthy list of screenings and other prevention services, but some beneficiaries still might miss out. Read story

Read story

How to get tax breaks for your medical practice

Federal, state and local governments offer doctors incentives because practices are recognized as economic engines. But physicians must know how and where to find them. Read story

Read story

Advance pay ACOs: A down payment on Medicare's future

Accountable care organizations that pay doctors up-front bring practice improvements, but it's unclear yet if program actuaries will see a return on investment. Read story

Read story

Physician liability: Your team, your legal risk

When health care team members drop the ball, it's often doctors who end up in court. How can physicians improve such care and avoid risks? Read story

  • Stay informed
  • Twitter
  • Facebook
  • RSS
  • LinkedIn