Title: Watts v. Lester E. Cox Med. Ctrs.

State: missouri

Issuer: Missouri Supreme Court

Document:

SUPREME COURT OF MISSOURI 
en banc 
 
 
 
Deborah Watts as Next Friend for  
) 
Naython Kayne Watts, 
 
 
) 
 
 
 
 
 
 
) 
 
Appellant/Cross-Respondent, 
)   
 
 
 
 
 
 
) 
vs. 
 
 
 
 
 
) 
No. SC91867 
 
 
 
 
 
 
) 
Lester E. Cox Medical Centers d/b/a 
) 
Family Medical Care Center, Lester E.  ) 
Cox Medical Centers, 
 
 
) 
 
 
 
 
 
 
) 
 
Respondent,  
 
 
) 
 
 
 
 
 
 
) 
Melissa R. Herrman, M.D., Matthew P. )  
Green, D.O., and William S. Kelly,  
) 
M.D.,  
 
 
 
 
) 
 
 
 
 
 
 
) 
 
Respondents/Cross-Appellants. 
) 
 
Appeal from the Circuit Court of Greene County 
Honorable Dan J. Conklin, Judge  
 
Opinion issued July 31, 2012 
 
 
Deborah Watts filed the underlying medical malpractice action alleging that her 
son, Naython Watts, was born with disabling brain injuries because Cox Medical Centers 
and its associated physicians (collectively, Cox) provided negligent health care services.  
The jury returned a verdict in favor of Watts and awarded $1.45 million in non-economic 
damages and $3.371 million in future medical damages.  The trial court entered a 
judgment reducing Watts’ non-economic damages to $350,000 as required by section 
538.210.1  The judgment also established a periodic payment schedule pursuant to section 
538.220.  The periodic payment schedule required immediate payment of half of all net 
future medical damages with the other half paid in equal annual installments over the 
next 50 years with an interest rate of 0.26 percent.   
 
Watts asserts that the section 538.210 cap on non-economic damages violates the 
right to trial by jury and several other provisions of the Missouri Constitution.2  Watts 
also asserts that the section 538.220 periodic payment schedule was arbitrary and 
unreasonable in that it does not assure full compensation due to the low interest rate and 
50-year payment schedule.   
 
Cox has filed a cross-appeal asserting that the trial court erred in its immediate 
award of future medical damages.  Cox asserts that section 538.220 prohibits a lump sum 
payment of a portion of future medical damages and, instead, requires that all future 
medical damages be paid pursuant to a periodic payment schedule regardless of when the 
need for the medical damage payments will arise.    
  
This Court holds that section 538.210 is unconstitutional to the extent that it 
infringes on the jury’s constitutionally protected purpose of determining the amount of 
                                                 
1 All statutory references to statutes are to RSMo 2000. 
2 Watts asserts that section 538.210 also violates the constitutional separation of powers, 
article II, section 1; equal protection, article I, section II; the prohibition against special 
legislation, article III, section 40; and the clear title and single subject requirements of 
article III, section 23 of the Missouri Constitution.  Because this Court finds that section 
538.210 violates the right to trial by jury in article I, section 22(a), these challenges need 
to be addressed.  Watts also asserts that section 538.220 violates equal protection and the 
right to due process.  This Court need not reach these issues because the trial court 
misapplied the statute, and this Court will not reach constitutional issues if the case can 
be decided on statutory grounds.    
 
damages sustained by an injured party.  Such a limitation was not permitted at common 
law when Missouri’s constitution first was adopted in 1820 and, therefore, violates the 
right to trial by jury guaranteed by article I, section 22(a) of the Missouri Constitution.  
Accordingly, the judgment is reversed to the extent that it caps non-economic damages 
pursuant to section 538.210.  To the extent that the decision in Adams By and Through 
Adams v. Children's Mercy Hosp., 832 S.W.2d 898, 907 (Mo. banc 1992), is inconsistent 
with this decision, it is overruled. 
 
This Court further holds that the trial court abused its discretion in entering a 
periodic payment schedule pursuant to section 538.220 that did not assure full 
compensation due to the interest rate and 50-year payment schedule.   
 
Finally, this Court holds that section 538.220 gives the judge the authority to 
determine the manner in which future damages shall be paid, including what portion 
should be paid in future installments as to both medical and other future damages.  Cox’s 
argument on cross-appeal that all future damages must be paid in a lump sum is rejected.   
In all other respects, the judgment is affirmed.  The case is remanded.  
I. Facts 
 
Cox provided prenatal care to Watts.  On October 30, 2006, when she was 
approximately 39 weeks pregnant, Watts went to a clinic associated with Cox because 
she was experiencing cramping and because she detected decreased fetal movement.  Dr. 
Herrman, who was then a third-year medical resident, examined Watts.  The evidence at 
trial indicated that Dr. Herrman did not perform appropriate tests, failed to notify Watts 
of the significance of decreased fetal movement and failed to perform any further 
 
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diagnostic monitoring.  Dr. Herrman’s supervisor, Dr. Kelly, signed off on Dr. Herrman’s 
findings.   
 
On November 1, 2006, Watts was admitted to the hospital due to lack of fetal 
movement.   Watts was placed on a fetal monitor at 9:10 a.m.  Watts’ expert, Dr. Roberts, 
testified that this diagnostic monitoring indicated fetal hypoxia and acidosis and that the 
standard of care required immediate Caesarean-section delivery.  Dr. Green, the second-
year medical resident who was examining Watts, did not begin the Caesarean section 
until 10:45 a.m.  Naython Watts was born with catastrophic brain injuries. 
 
Watts sued Cox, claiming that its doctors’ malpractice caused Naython’s brain 
injuries.  After trial, the jury returned a verdict in favor of Watts and awarded $1.45 
million in non-economic damages and $3.371 million in future medical damages.  The 
jury then reduced the future medical damages to present value pursuant to section 
538.220.  The jury reduced the future damages at a rate of 4 percent per annum, the 
estimated yield on a safe long-term investment, which worked out to a present value of 
$1,747,600.  Cox then requested that it be permitted to pay the future damages in periodic 
payments pursuant to section 538.220.  In response, the trial court entered a payment 
schedule under which half of the future damages would be paid immediately in a lump 
sum and half would be paid over a 50-year period at a statutorily required interest rate of 
0.26 percent..  
 
II. Standard of Review 
 
This Court has exclusive jurisdiction over this appeal because it involves a 
challenge to the validity of a statute of this state.  Mo. Const. article V, section 3.  Watts’ 
 
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constitutional challenge to the validity of section 538.210 is subject to de novo review.  
Rentschler v. Nixon, 311 S.W.3d 783, 786 (Mo. banc 2010).   “A statute is presumed 
valid and will not be held unconstitutional unless it clearly contravenes a constitutional 
provision.”  Id. at 786.   Watts has the burden of proving that the statutes “clearly and 
undoubtedly” violate the constitution.  Id.  
 
Watts’ argument that the trial court erred by requiring one-half of future medical 
damages to be paid pursuant to a section 538.220 periodic payment schedule “is subject 
to review only on the basis of its arbitrariness.”  Vincent by Vincent v. Johnson, 833 
S.W.2d 859, 866 (Mo. banc 1992).  Appellate courts ask whether a circuit court abused 
its discretion in crafting a periodic payment schedule for future damages.  Davolt v. 
Highland, 119 S.W.3d 118, 139 (Mo. App. 2003).  “A trial court will be found to have 
abused its discretion when a ruling is clearly against the logic of the circumstances then 
before the court and is so arbitrary and unreasonable as to shock the sense of justice and 
indicate a lack of careful consideration.”  Klotz v. St. Anthony’s Medical Center, 311 
S.W.3d 752, 760 (Mo. banc 2010)(quoting Swartz v. Gale Webb Transp. Co., 215 S.W.3d 
127, 129-130 (Mo. banc 2007)).   
 
Cox’s cross appeal asserts that section 538.220 requires all future medical 
damages to be paid according to a periodic payment schedule.  This is a statutory 
interpretation argument subject to de novo review.  Spradling v. SSM Health Care St. 
Louis, 313 S.W.3d 683, 686 (Mo. banc 2010).  This Court’s role in interpreting statutes is 
to discern the intent of the legislature from the plain and ordinary meaning of the 
language used and to give effect to that intent, if possible.  Id.   
 
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III.  Section 538.210 Violates the Right to Trial by Jury 
Watts asserts that the $350,000 cap on non-economic damages established by 
section 538.210 violates the right to trial by jury guaranteed by article I, section 22(a) of 
the Missouri Constitution, which provides that “the right of trial by jury as heretofore 
enjoyed shall remain inviolate ….”  Cox notes correctly that in AdamsI, the Court held 
that the statutory cap on non-economic damages does not violate the right to trial by jury.  
Cox asserts that Adams is dispositive.  Watts asserts that Adams was decided wrongly and 
should be overruled.  
A. 
Article I, Section 22(a) Requires that the Right of Trial by Jury as 
Heretofore Enjoyed Shall Remain Inviolate 
 
Article I, section 22(a) is one of the fundamental guarantees of the Missouri 
Constitution, providing “the right of trial by jury as heretofore enjoyed shall remain 
inviolate ….”  The plain language of article I, section 22(a) requires analysis of two 
propositions to determine if the cap imposed by section 538.210 violates the state 
constitutional right to trial by jury.   
The first portion of article I, section 22(a) requires a determination of whether 
Watts’ medical negligence action and claim for non-economic damages is included 
within “the right of trial by jury as heretofore enjoyed.”  The phrase “heretofore enjoyed” 
means that “[c]itizens of Missouri are entitled to a jury trial in all actions to which they 
would have been entitled to a jury when the Missouri Constitution was adopted” in 1820.  
State ex rel. Diehl v. O'Malley, 95 S.W.3d 82, 85 (Mo. banc 2003).  In the context of this 
case, the scope of that right also is defined by common law limitations on the amount of a 
 
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jury’s damage award.  See, Klotz, 311 S.W.3d at 775 (Wolff, J., concurring).  Therefore, 
if Missouri common law entitled a plaintiff to a jury trial on the issue of non-economic 
damages in a medical negligence action in 1820, Watts has a state constitutional right to a 
jury trial on her claim for damages for medical malpractice. 
The second portion requires this Court to determine whether the right to trial by 
jury “remain[s] inviolate” when a statutory cap requires courts to reduce the jury’s 
verdict.  The plain meaning of the word “inviolate” means “free from change or blemish, 
pure or unbroken.”  WEBSTER’S THIRD NEW INTERNATIONAL DICTIONARY 1190 (1993).  
Therefore, if the statutory cap changes the common law right to a jury determination of 
damages, the right to trial by jury does not “remain inviolate” and the cap is 
unconstitutional. 
B. 
The Nature of the Right To Jury Trial Heretofore Enjoyed 
 
To determine the nature of the right to trial by jury as “heretofore enjoyed,” a 
court must assess the state of the common law when the Missouri Constitution was 
adopted in 1820.  Diehl, 95 S.W.3d at 85.  Missouri’s common law is based on the 
common law of England as of 1607.  Section 1.010.  English common law recognized 
medical negligence as one of five types of “private wrongs” that could be redressed in 
court.  2 W. Blackstone, Commentaries on the Laws of England 122 (1765; 1992 reprint).  
English common law also permitted recovery of non-economic damages to give “the 
sufferer a pecuniary satisfaction.”  3 W. Blackstone, Commentaries on the Laws of 
England 1112 (1765; 1992 reprint).  Similarly, Missouri’s territorial laws that pre-dated 
 
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statehood provided for jury trials in “all civil cases of the value of one hundred dollars ... 
if either of the parties require it.”  Mo. Terr.  Laws 58, sec. 13; Diehl, 95 S.W.3d at 85.   
Accordingly, civil actions for damages resulting from personal wrongs have been 
tried by juries since 1820.  Diehl, 95 S.W.3d at 92.  Watts’ action for medical negligence, 
including her claim for non-economic damages, “falls into that category” and is the same 
type of case that was recognized at common law when the constitution was adopted in 
1820.  Rice v. State, 8 Mo. 561 (Mo. 1844)(medical negligence claims, referred to as 
“imperitia meidi culpu annumeratur,” are a “well settled” part of the “civil law”); see 
also Klotz, 311 S.W.3d at 775 (Wolff, J., concurring) (Mo. banc 2010); Atlanta 
Oculoplastic Surgery P.C. v. Nestlehutt, 691 S.E.2d 218, 222 (Ga. 2010)(“non-economic 
damages have long been recognized as an element of total damages in tort cases, 
including those involving medical negligence”).   Watts has a right to trial by jury on her 
claim for non-economic damages caused by medical negligence. 
The scope of Watts’ right to a jury trial, like the existence of the right, also is 
defined by Missouri’s common law at the time the Missouri Constitution was adopted in 
1820.  By the late 1600s, the English common law authorized  judges to exercise control 
over juries by granting new trials in cases in which the verdict was deemed inconsistent 
with the evidence.  Theodore F.T. Plucknett, A CONCISE HISTORY OF THE COMMON LAW 
135 (5th ed. 1956) cited in Klotz, 311 S.W.3d at 776 (Wolff, J., concurring).  Although 
English common law recognized the validity of some judicial control over jury verdicts, 
in Dimick v. Schiedt, 293 U.S. 474 (1935), the United States Supreme Court, using the 
same historical analysis required for Missouri’s right to jury trial, found that there were 
 
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few common law precedents authorizing judicial remittitur but that the procedure was a 
part of the common law and, consequently, a part of the federal constitutional jury trial 
right.  293 U.S. at 482-483.  This remittitur procedure has been followed since in the 
federal courts.  Klotz, 311 S.W.3d at 776 (Wolff, J., concurring). 
Like the English and early American common law, Missouri state common law 
also has recognized judicial remittitur.  For instance, one of this Court’s earliest cases 
following statehood stated that “if the jury find greater damages than the plaintiff has 
counted for, [and] the Court render judgment according to such finding, it is error.”  
Klotz, 311 S.W.3d at 777 (Wolff, J., concurring)(quoting, Carr & Co. v. Edwards, 1 Mo. 
137, 137 (Mo. 1821)).  Similarly, in Hoyt v. Reed, 16 Mo. 294, 294 (1852), the Court 
affirmed the trial court’s remittitur of damages because the jury erroneously included an 
item for which the defendant was not liable.  See also Klotz, 311 S.W.3d at 778 (Wolff, 
J., concurring).  Judicial remittitur was and is an established concept in Missouri’s 
common law. 
Although early Missouri cases approved of judicial remittitur, there are cases that 
have held that judicial remittitur is improper.  For instance, in Gurley v. Mo. Pac., 16 
S.W. 11, 17 (Mo. 1891), the Court refused to remit the damages in a personal injury case 
because, “[w]hen we set aside any part of the verdict, we destroy its integrity, and we 
have no right to set ourselves up as triers of facts, and render another and different 
verdict.”  Gurley stated that if a jury verdict clearly was based on passion or prejudice, 
the proper remedy was to set it aside in its entirety, but that absent such passion or 
prejudice, it should be upheld.  Id.   Likewise, in Rodney v. St. Louis S. W. Ry., 30 S.W. 
 
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150, 150 (Mo. 1895), and again in Firestone v. Crown Ctr. Redevelopment Corp., 693 
S.W.2d 99, 110 (Mo. banc 1985), this Court held that judicial remittitur was not a valid 
exercise of judicial power.   
Although the precedent regarding judicial remittitur is inconsistent precedent, the 
inconsistency stems from a long-standing reluctance in the common law to tamper with 
the jury’s constitutional role as the finder of fact.  As noted by Judge Wolff in his 
concurring opinion in Klotz, 311 S.W.3d at 774, this history demonstrates that statutory 
caps on damage awards simply did not exist and were not contemplated by the common 
law when the people of Missouri adopted their constitution in 1820 guaranteeing that the 
right to trial by jury as heretofore enjoyed shall remain inviolate.  The right to trial by 
jury “heretofore enjoyed” was not subject to legislative limits on damages.   
C. 
Do Damage Caps Allow the Right to Jury Trial to Remain Inviolate? 
Having established that the right to trial by jury “heretofore enjoyed” did not 
include legislative limits on damages, the next inquiry is whether the right to trial by jury 
“remain[s] inviolate” after application of the section 538.210 cap on non-economic 
damages. 
1. 
The Amount of Damages is a Fact for the Jury to Determine. 
Missouri law long has recognized that one of the jury’s primary functions is to 
determine the plaintiff’s damages.   For instance, in Richardson v. State Highway & 
Transp. Comm’n, 863 S.W.2d 876 (Mo. banc 1993), this Court recognized that 
Missouri’s constitution gives the jury the right and responsibility to determine damages, 
stating, “[T]he jury here assessed liability and determined damages, thus fulfilling its 
 
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constitutional task.”  Id. at 880; accord, Klotz, 311 S.W.3d at 775 (Wolff, J., concurring).  
Likewise, even though Adams held that a cap on non-economic damages did not violate 
the right to trial by jury, the Court still recognized that the “jury’s primary function is 
fact-finding. This includes a determination of a plaintiff’s damages.”  832 S.W.2d at 907.   
It is beyond dispute that Missouri law always has recognized that “the jury’s role in a 
civil case is to determine the facts relating to both liability and damages and to enter a 
verdict accordingly.”  Estate of Overbey v. Chad Franklin Nat’l Auto Sales N., LLC, 361 
S.W.3d 364, 382 (Mo. banc 2012).3   Like any other type of damages, the amount of non-
economic damages is a fact that must be determined by the jury and is subject to the 
protections of the article I, section 22(a) right to trial by jury.   
 
2.       Section 538.210 violates the right to trial by jury. 
Once the right to a trial by jury attaches, as it does in this case, the plaintiff has the 
full benefit of that right free from the reach of hostile legislation.  Section 538.210 
imposes a cap on the jury’s award of non-economic damages that operates wholly 
independent of the facts of the case.  As such, section 538.210 directly curtails the jury’s 
determination of damages and, as a result, necessarily infringes on the right to trial by 
                                                 
3 The United States Supreme Court also has recognized that the jury’s primary role is to 
ascertain the facts of a case.   The “controlling distinction between the power of the court and 
that of the jury is that the former is the power to determine the law and the latter to determine the 
facts.”  Dimick, 293 U.S. at 486.  This means that, even when a verdict is set aside as excessive 
due to bias or prejudice, the court must allow the winning party a right to a new trial because 
both plaintiff and defendant:  
[R]emain entitled, as they were entitled in the first instance, to have a jury 
properly determine the question of liability and the extent of the injury by an 
assessment of damages. Both are questions of fact. 
  
Id.   
 
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jury when applied to a cause of action to which the right to jury trial attaches at common 
law.  Because the common law did not provide for legislative limits on the jury’s 
assessment of civil damages, Missouri citizens retain their individual right to trial by jury 
subject only to judicial remittitur based on the evidence in the case.  Statutory damage 
caps were not permissible in 1820 and, pursuant to the plain language of article I, section 
22(a), remain impermissible today.  Statutory caps on damages in cases in which the right 
to trial by jury applies necessarily changes and impairs the right of trial by jury “as 
heretofore enjoyed.”   The individual right to trial by jury cannot “remain inviolate” when 
an injured party is deprived of the jury’s constitutionally assigned role of determining 
damages according to the particular facts of the case.  Section 538.210 necessarily and 
unavoidably violates the state constitutional right to trial by jury.  
The foregoing analysis has been utilized by a number of other states with 
constitutions that, like Missouri’s, require that the right to jury trial shall “remain 
inviolate.”  These states also have concluded that, because the assessment of damages is 
one of the factual findings assigned to the jury rather than to a judge, any limit on 
damages that restricts the jury’s fact-finding role violates the constitutional right to trial 
by jury.   
For instance, in Sofie v. Fibreboard Corp., 771 P.2d 711 (Wash. 1989), the court 
recognized “that the jury’s fact-finding function included the determination of damages.  
This evidence can only lead to the conclusion that our constitution … protects the jury’s 
role to determine damages.”  Id. at 716.  Consequently, “‘when you start to put 
limitations on [the jury’s ability to find damages], you have, in fact, invaded the province 
 
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of the jury and have not preserved the right to a trial by jury inviolate.’”  Id. at 722 
(quoting Washington Senate Journal, 49th Legislature 1986, at 449).   
Lakin v. Senco Prod., Inc., 987 P.2d 463 (Or. 1999), similarly held “[t]he amount 
of damages … from the beginning of trial by jury, was a ‘fact’ to be found by jurors,” 
therefore, a statutory cap violates the right to jury trial because “to the extent that the 
jury’s award exceeds the statutory cap, the statute prevents the jury’s award from having 
its full and intended effect.”  Id. at 470-73 (quoting Charles T. McCormick, Handbook on 
the Law of Damages 24 (1935)).   
Nestlehutt and Moore v. Mobile Infirmary Ass’n, 592 So. 2d 156 (Ala. 1991), 
reached similar conclusions.  Noting that Dimick held that “the determination of damages 
rests ‘peculiarly within the province of the jury,’” Nestlehutt also concluded that “caps 
infringe on a party’s constitutional right … to a jury determination as to noneconomic 
damages.”  691 S.E.2d at 222-23 (quoting Dimick, 293 U.S. at 480).  Moore held that 
statutory damage caps on common law causes of action violate the right to trial by jury 
because “the trial judge is required summarily to disregard the jury’s assessment of the 
amount of noneconomic loss, that species of damages lying most peculiarly within the 
jury’s discretion.”  592 So.2d at 163. 
Smith v. Dep’t of Ins., 507 So. 2d 1080 (Fla. 1987), similarly recognizes that a 
limitation on the amount of damages that can be recovered by an injured party violates 
the Florida constitution’s guarantee of both the right to jury trial and the right of access to 
courts, stating: 
Access to courts is granted for the purpose of redressing injuries. A plaintiff 
 
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who receives a jury verdict for, e.g., $1,000,000, has not received a 
constitutional redress of injuries if the legislature statutorily, and arbitrarily, 
caps the recovery at $450,000.  Nor, we add, because the jury verdict is 
being arbitrarily capped, is the plaintiff receiving the constitutional benefit 
of a jury trial as we have heretofore understood that right. Further, if the 
legislature may constitutionally cap recovery at $450,000, there is no 
discernible reason why it could not cap the recovery at some other figure, 
perhaps $50,000, or $1,000, or even $1. 
 
Id. at 1088-89.   
 
This Court holds that section 538.210 violates the article I, section 22(a) right to  
trial by jury. 
3.    Adams Violates the Right to a Jury Determination of Damages. 
Cox asserts, consistent with the rationale in Adams, that the section 538.210 cap 
on non-economic damages does not limit the jury’s constitutional role in determining 
damages because the jury remains free to award damages consistent with the evidence in 
the case.   Adams held that section 538.210 does not violate the right to trial by jury 
because the cap is applied by the trial court after the “jury completed its constitutional 
task” of determining the plaintiff’s economic and non-economic damages.  Id at 907.   
Although recognizing that the jury’s “primary function” is to find facts, including the 
amount of damages, Adams reasoned that a statutory cap on damages lets the jury do its 
job and then simply directs the court not to enter the full amount of the verdict in the 
judgment if the amount of non-economic damages exceeds the statutory cap.  Id.   In 
other words, application of the damage cap “is a matter of law, not fact, and not within 
the purview of the jury.”  Id.  Furthermore, Adams found that even if a damages cap 
interferes with the jury’s determination of damages, it does not violate the right to jury 
 
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trial because that right does not protect the jury’s determination of damages.  Id.  
There are four flaws in the Adams rationale.  First, Adams fundamentally 
misconstrues the nature of the right to trial by jury.  While article I, section 22(a) sets the 
constitutional role of the jury, it does so by guaranteeing an individual right to a trial by 
jury.  The application of section 538.210 may permit the jury to perform its constitutional 
role, but it deprives the individual of his or her right to the damages awarded by the jury.  
The constitutional significance of the jury’s role in determining damages is reflected in 
the analytical basis for determining whether the right to trial by jury attaches -- if the 
action is a civil action for damages, then the right to a jury trial attaches and must 
“remain inviolate.”  Diehl, 95 S.W.3d. at 84.  Because the constitutional right to a civil 
jury trial is contingent upon there being an action for damages, statutory limits on those 
damages directly curtail the individual right to one of the most significant constitutional 
roles performed by the jury -- the determination of damages.   The argument that section 
538.210 does not interfere with the right to trial by jury because the jury had a practically 
meaningless opportunity to assess damages simply “pays lip service to the form of the 
jury but robs it of its function.” Sofie, 771 P.2d at 721; see also Nestlehutt, 691 S.E.2d at 
223 (“[b]y requiring the court to reduce a noneconomic damages award determined by a 
jury that exceeds the statutory limit, [a statutory cap] clearly nullifies the jury’s findings 
of fact regarding damages and thereby undermines the jury’s basic function”);  Moore, 
592 So. 2d at 164 (“[b]ecause the statute caps the jury’s verdict automatically and 
absolutely, the jury’s function, to the extent the verdict exceeds the damages ceiling, 
assumes less than an advisory status”)(emphasis in original).   
 
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Second, Adams further misconstrues the right to trial by jury because it 
specifically permits legislative limitation of an individual constitutional right.  Adams 
justifies the section 538.210 damage cap because the jury nominally is permitted to find 
the facts while the judge statutorily is required to make a separate legal determination that 
applies the damages cap.  The unavoidable result of this rationale is that right to trial by 
jury is directly subject to legislative limitation.  This holding is untenable for the simple 
reason that a statutory limit on the state constitutional right to trial by jury amounts to an 
impermissible legislative alteration of the Constitution.  Diehl, 95 S.W.3d at 85, 92 “[t]he 
right to trial by jury, where it applies, is a constitutional right, applies ‘regardless of any 
statutory provision,’ and is ‘beyond the reach of hostile legislation’”)(citing Lee v. 
Conran, 111 S.W. 1151, 1153 (Mo. 1908)); see also Missouri Alliance of Retired Am. v. 
Dept. of Labor and Indust. Relations, 277 S.W.3d 670, 682 (Mo. banc 2009)(a statute 
may not infringe on a constitutional right; if the two are in conflict, then it is the statute 
rather than the constitution that must give way).   
Adams did not acknowledge, must less distinguish, the myriad cases recognizing 
that a statute may not limit constitutional rights, which are beyond the reach of hostile 
legislation.  Instead, it cited to De May v. Liberty Foundry Co., 37 S.W.2d 640 (Mo. 
1931), to argue that the legislature could abolish a common law cause of action for 
damages against an employer when it substituted a system of workers’ compensation in 
its stead, and then said that if this were true, then it must be that “[i]f the legislature has 
the constitutional power to create and abolish causes of action, the legislature also has the 
power to limit recovery in those causes of action.”  Adams, 832 S.W.2d at 907.  
 
16
This statement is Adams’ total analysis on this issue, and other cases upholding 
statutory damage caps simply repeat this mantra.  They do so without any further analysis 
and without addressing how this reasoning can stand in the face of their continued 
recognition that statutes cannot limit constitutional rights.  Indeed, if the two were 
equivalent, then it would be De May and similar cases that would have to be overruled.  
But De May itself recognized that its analysis, even if it is accepted as valid, applies only 
“when the cause of action cognizable at law is abrogated or removed” – that is, it held 
only that if there is no cause of action, there is nothing to which the right to jury trial can 
attach.  Id. at 649.  Nothing in it suggested a legislature can take constitutional 
protections from a plaintiff seeking relief under existing causes of action.  If that could be 
done, it would make constitutional protections of only theoretical value – they would 
exist only unless and until limited by the legislature.  Such rights would not be rights at 
all but merely privileges that could be withdrawn.    
Third, Adams cites to the United States Supreme Court decision in Tull v. United 
States, 481 U.S. 412 (1987), for the proposition that the right to jury trial does not extend 
to the determination of damages, even though determining the facts is the jury’s primary 
function. As established above, Missouri law long has recognized that the jury’s role is 
precisely to determine both liability and damages and, further, that the article I, section 
22(a) right to trial by jury protects the individual right to a jury determination of 
damages.  Moreover, Tull is irrelevant because it interprets the federal constitution and 
deals only with civil penalties, not common law damages.  See Sofie, 771 P.2d at 725.  In 
Tull, the Supreme Court held that the Seventh Amendment right to trial by jury was not 
 
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violated by a federal statute that permitted the trial judge to set the amount of a civil 
penalty.  The Supreme Court held that a litigant has the right to have a jury determine 
liability, but does not have a constitutional right to a jury determination of a civil penalty.  
Id. at 426.  The Court reasoned that, with respect to federal constitutional right to a jury 
trial, “only … those incidents which are regarded as fundamental, as inherent in and of 
the essence of the system of trial by jury, are placed beyond the legislature” and that the 
assessment of a civil penalty is not one of those “most fundamental elements.” Id.  The 
irrelevance of Tull to the jury trial analysis was confirmed in Feltner v. Columbia 
Pictures Television, Inc., in which the Court stated that: 
 In Tull ... we were presented with no evidence that juries historically had 
determined the amount of civil penalties to be paid to the Government.  
Moreover, the awarding of civil penalties to the Government could be 
viewed as analogous to sentencing in a criminal proceeding. Here, of 
course, there is no similar analogy, and there is clear and direct historical 
evidence that juries, both as a general matter and in copyright cases, set the 
amount of damages awarded to a successful plaintiff. Tull is thus 
inapposite. As a result, if a party so demands, a jury must determine the 
actual amount of statutory damages under [the Copyright Act] in order to 
preserve “the substance of the common-law right of trial by jury.”  
 
523 U.S. 340, 355 (1998) (quoting Tull, 481 U.S. at 426) (internal citations 
omitted) (emphasis added).   
Additionally, Adams reaches its conclusion without citation to any applicable 
Missouri law.  Instead, Adams relies on a Virginia case, Etheridge v. Med. Ctr. Hosp., 
376 S.E.2d 525 (Va. 1989), and Tull.  In addition to the fact that the interpretation of the 
Missouri Constitution should be informed by Missouri law, Adams failed to note that 
Etheridge is analytically irrelevant because, unlike Missouri’s guarantee that the right to 
 
18
trial by jury shall “remain inviolate,” the Virginia Constitution merely states that “trial by 
jury is preferable to any other, and ought to be held sacred.”  Va. Const. art. I, § 11.  The 
Virginia Constitution simply does not provide the same unyielding jury trial right as that 
provided by the Missouri Constitution, which demands that the right “remain inviolate.”  
The different language entails a different analysis. See also Nestlehutt, 691 S.E.2d at 224 
n.8 (noting that Virginia has a “less comprehensive constitutional jury trial provision” 
and, on this basis, finding Etheridge unpersuasive).  Adams erred in relying on Etheridge 
instead of the plain language of article I, section 22(a) and Missouri common law 
precedent. 
The preceding analysis shows that the reasoning of Adams and the cases it relied 
on are flawed.  The only remaining reason to uphold Adams would be stare decisis 
considerations.  “The doctrine of stare decisis promotes security in the law by 
encouraging adherence to previously decided cases.”  Independence-Nat. Educ. Ass’n v. 
Independence Sch. Dist., 223 S.W.3d 131, 137 (Mo. banc 2007).  “But, the adherence to 
precedent is not absolute, and the passage of time and the experience of enforcing a 
purportedly incorrect precedent may demonstrate a compelling case for changing 
course.”  Med. Shoppe Intern., Inc. v. Dir. of Revenue, 156 S.W.3d 333, 335 (Mo. banc 
2005).   
Overturning erroneous precedent is particularly important where the precedent 
violates a constitutional right because: 
If the people are dissatisfied with the construction of a statute, the 
frequently recurring sessions of the legislature afford easy opportunity to 
repeal, alter, or modify the statute, while the constitution is organic, 
 
19
intended to be enduring until changed conditions of society demand more 
stringent or less restrictive regulations, and, if a decision construes the 
constitution in a manner not acceptable to the people, the opportunity of 
changing the organic law is remote. Moreover, no set of judges ought to 
have the right to tie the hands of their successors on constitutional 
questions, any more than one general assembly should those of its 
successors on legislative matters. 
 
Mountain Grove Bank v. Douglas Cnty., 47 S.W. 944, 947 (Mo. 1898).  
Applying these principles, while this Court always is hesitant to overturn 
precedent, it nonetheless has followed its obligation to do so where necessary to protect 
the constitutional rights of Missouri’s citizens.  For example, in Independence, the Court 
was required to interpret the meaning of article I, section 29 of Missouri’s constitution, 
which commands that “employees shall have the right to collectively bargain.”  Mo. 
Const., art. I, § 29.  This constitutional provision does not limit the right to bargain 
collectively only to private sector employees, as City of Springfield v. Clouse, 206 
S.W.2d 539 (Mo. banc 1947), had stated.  This Court, therefore, overruled Clouse, 
stating: 
Clouse contradicts the plain meaning of article I, section 29, which states 
that employees, without qualification, have the right to collective 
bargaining.  Deviations from clear constitutional commands – although 
longstanding – do not promote respect for the rule of law.  If the people 
want to change the language of the constitution, the means are available to 
do so.  This Court will not change the language the people have adopted.  
Clouse is overruled. 
 
223 S.W.3d at 137 (emphasis in original) (internal citations omitted).   
Similarly, in State v. Baker, 524 S.W.2d 122 (Mo. banc 1975), the Court 
addressed the constitutional validity of a statute imposing mandatory consecutive 
sentences on defendants who were found guilty of a second offense prior to being 
 
20
sentenced for their first offense, a consequence that Missouri statutes did not 
impose on those who already had been sentenced on their first offense prior to 
being found guilty of their second offense. This Court overruled precedent 
upholding the statute because it found this irrational difference in treatment of 
comparably situated defendants violated defendants’ equal protection rights.  Id. at 
129-31.  Likewise, Barker v. St. Louis Cnty., 104 S.W.2d 371 (Mo. 1937), 
reviewed the constitutional validity of a statute that required an owner to seek 
compensation within 20 days of a government taking or waive his right to 
compensation.  Id. at 377.  Barker found that the statute violated the plain 
language of article II, section 21 of the Constitution of 1875, which stated, 
“[P]rivate property shall not be taken or damaged for public use without just 
compensation.”  Id. at 377-78.  Although Petet v. McClanahan, 249 S.W. 917 
(Mo. 1923), had upheld the statute, the Court found that it was impelled to 
overrule that case because “if there is no doubt that a statute … is in conflict with 
the Constitution, then it is the duty of any court, whose duty it is to decide, to 
declare the conflict and declare the statute void.”  Barker, 104 S.W.2d at 377.4   
                                                 
4 Other cases overruling prior case interpretations of a constitutional provision include 
Hampton v. Big Boy Steel Erection, 121 S.W.3d 220 (Mo. banc 2003)(overturning dozens 
of cases that previously had found that, under article V, section 18 of the Missouri 
Constitution, courts must view the evidence in administrative decisions in a light most 
favorable to the decision); Alumax Foils Inc. v. City of St. Louis, 939 S.W.2d 907 (Mo. 
banc 1997)(overturning a half century of precedent and finding that municipal ordinances 
that raise revenue are not “revenue laws of this state” under article V, section 3 of the 
Missouri Constitution because such ordinances “raise[] revenue only within a single 
political subdivision for the benefit of that political subdivision.”); Mercantile Bank of 
Illinois, N.A. v. Sch. Dist. of Osceola, 834 S.W.2d 737 (Mo. banc 1992)(reversing 
 
21
Adams’ erroneous interpretation of article I, section 22(a) of Missouri’s 
constitution negated the guarantee of that section that the right of Missouri citizens to 
jury trial as heretofore enjoyed shall remain inviolate.  It permitted legislative enactments 
to infringe on this constitutional guarantee, turning what was a right into a mere privilege.  
Adams is overruled to the extent that it holds that the section 538.210 caps on non-
economic damages do not violate the right to trial by jury.  Because the trial court 
reduced the non-economic damages in reliance on Adams, that aspect of the judgment is 
reversed. 
IV. Section 538.220 
 
Watts asserts that the periodic payment schedule set out in section 538.220 is 
arbitrary and unreasonable in that it prevents a plaintiff from receiving the full amount of 
compensation awarded by the jury.  This Court has recognized that the general purpose of 
chapter 538 is to reduce the cost of medical malpractice and that the specific purpose of 
section 538.220 is to spread that cost over time and to guard against squandering the 
                                                                                                                                                             
precedent and finding that the prohibition on subdivisions carrying debt in article VI, 
section 26(a) did not preclude subdivisions from entering into contracts that obligated 
them to make payments in future years); Barnes Hosp. v. Leggett, 589 S.W.2d 241 (Mo. 
1979)(overruling earlier cases that held that if any part of a building was used for profit 
none of the building could be excluded from property taxes under the charitable 
exception in article X, section 6); State ex rel. Stanhope v. Pratt, 533 S.W.2d 567 (Mo. 
banc 1976)(overturning nearly a century of precedent and holding that imprisonment for 
contempt for failure to pay alimony did not violate article I, section 11’s prohibition on 
imprisoning people for failure to pay debt as long as the person was financially able to 
pay); and Hill v. State Dept. of Public Health and Welfare, 503 S.W.2d 6, 10-11 (Mo. 
banc 1973)(reversing precedent and finding that “welfare benefits are in the nature of 
property rights … and as such are ‘private rights’ within the meaning of [the 
Constitution].”).  
 
22
judgment while reducing future burdens on government social services.   Vincent, 833 
S.W.2d at 867.  Section 538.220 states in relevant part: 
At the request of any party to such action made prior to the entry of 
judgment, the court shall include in the judgment a requirement that 
future damages be paid in whole or in part in periodic or installment 
payments if the total award of damages in the action exceeds one 
hundred thousand dollars.  Any judgment ordering such periodic or 
installment payments shall specify a future medical periodic payment 
schedule, which shall include the recipient, the amount of each 
payment, the interval between payments, and the number of 
payments.  The duration of the future medical payment schedule shall 
be for a period of time equal to the life expectancy of the person to 
whom such services were rendered, as determined by the court, based 
solely on the evidence of such life expectancy presented by the 
plaintiff at trial.  The amount of each of the future medical periodic 
payments shall be determined by dividing the total amount of future 
medical damages by the number of future medical periodic payments.  
The court shall apply interest on such future periodic payments at a 
per annum interest rate no greater than the coupon issue yield 
equivalent, as determined by the Federal Reserve Board, of the 
average accepted auction price for the last auction of fifty-two-week 
United States Treasury bills settled immediately prior to the date of 
the judgment.  The judgment shall state the applicable interest rate.  
The parties shall be afforded the opportunity to agree on the manner 
of payment of future damages, including the rate of interest, if any, to 
be applied, subject to court approval.  However, in the event the 
parties cannot agree, the unresolved issues shall be submitted to the 
court for resolution, either with or without a post-trial evidentiary 
hearing which may be called at the request of any party or the court.  
If a defendant makes the request for payment pursuant to this section, 
such request shall be binding only as to such defendant and shall not 
apply to or bind any other defendant. 
 
(Emphasis added).   
The first two sentences and the second-and-third-to-last sentences, italicized 
above, apply to the award of all types of future damages, while the middle sentences, not 
italicized above, apply to the special case of periodic future medical payments should 
 
23
they be ordered.  Looking at the portions of the statute addressing future damages 
generally, once the defendant requests a periodic payment schedule for future damages, 
then the first sentence of section 538.220.2 plainly requires the trial court to “include in 
the judgment a requirement that future damages be paid in whole or in part in periodic or 
installment payments.”  Id.; see also Davolt v. Highland, 119 S.W.3d 118, 138 (Mo. App. 
2003).  The second-and third-to-last sentences of the section make it clear that, in the 
final analysis, it was up to the court to determine how large a part of the future damages 
would be included in such future periodic payments, for it says that the court must 
approve any agreement of the parties as to the manner of payment and interest rate to be 
paid and that, if no agreement is reached, then the court shall resolve the manner of future 
payments and the interest to be paid.  These provisions expressly left the issue of how to 
pay future damages and at what interest rate in the hands of the court.   
Here, the future damages as to which periodic payment was requested were all 
future medical damages.  The middle portion of section 538.220.2 is directly specifically 
at the manner of paying this type of future damages.  It requires that payments be spread 
out in equal payments over the recipient’s life expectancy and determined by reference to 
a particular interest-rate benchmark.  It takes from the court and the parties the 
opportunity to agree upon a different interest rate and payment schedule.  But it does not 
remove from the court its authority to determine what part of the future medical damages 
shall be subject to the payment schedule, for the first sentence of section 538.220.2 
 
24
expressly applies to all future damages, and no portion of the statute addressing future 
medical damages removes this authority from the trial courts.5 
The statute grants the trial court discretion as to whether to award future medical 
damages wholly in periodic payments or in part in a lump sum.  Each plaintiff’s future 
medical costs will be spread out over vastly differing time horizons.  Some injured parties 
may require surgery or other extensive care in the period immediately following trial, 
while others may have only minimal immediate medical needs because their condition is 
chronic or the onset of some symptoms will not reach their peak for some years.  The 
legislature did not intend that the plaintiff who needs an immediate operation or has other 
immediate medical or medical-device needs not receive sufficient funds to pay for their 
needs until years hence, nor did it intend that a potentially hostile opposing party decide 
whether an injured person will receive sufficient funds to pay for medical needs in a 
timely manner. 
If more than one interpretation of a statute is possible, this Court will interpret a 
statute in a manner that renders it constitutional.  State ex rel. Praxair, Inc. v. Missouri 
Public Serv. Comm’n, 344 S.W.3d 178, 187 n. 7 (Mo. banc 2011).  This Court, therefore, 
interprets the statute to permit the trial court to consider the needs of the plaintiff and the 
facts of the particular case in deciding what portion of future medical damages will be 
                                                 
5 The dissent would find that the “in whole or in part” language “simply requires the trial 
court to comply with the party’s request if they ask for a partial lump sum and partial 
installment payment plan” for future damages owed.  Nothing in the statute, however, 
invests the parties with the power to determine if all or only part of future damages 
should be included in the periodic payment schedule. 
 
25
paid in a lump sum and what portion will be paid out over a periodic payment schedule 
that accords with the parameters set out in the statute.   
Cox’s cross-appeal is denied because the statute does not require that all future 
medical damages be paid according to a payment schedule.  
Watts asserts the section 538.220 periodic payment schedule was arbitrary and 
unreasonable in that it does not assure full compensation due to the low interest rate and 
50-year payment schedule.  The jury, as required by section 538.215, discounted 
Naython’s future medical damages to present value.  The requirement that future medical 
damages be discounted to present day value necessarily means that full compensation for 
those future damages is, in large part, dependent on the statutory interest rate being the 
same as the rate of health care inflation over the course of the payment schedule.  Watts 
offered expert testimony from two economists who concluded that the 50-year payment 
schedule, coupled with a 0.26 percent interest rate, virtually guaranteed that inflation in 
health care costs would result in Naython having insufficient funds to pay his future 
medical costs.  Under these circumstances, the periodic payment schedule affords none of 
the financial security intended by the statute.  Although section 538.220.2 required the 
court to establish some periodic payment schedule, once a present value reduction was 
made, use of an inconsistent future damages interest rate guaranteed that the jury’s 
damages award would not actually cover Naython’s future medical damages and, 
therefore, would take from him the full value of the jury’s award.  Consequently, the 
judgment is reversed and the case is remanded.  On remand, the court shall enter a new 
periodic payment schedule that, consistent with the goal of reducing medical malpractice 
 
26
 
27
costs, also ensures that Naython will receive the benefit of the jury’s award for future 
medical care. 
V. Conclusion 
 
The judgment is reversed to the extent it caps non-economic damages pursuant to 
section 538.210.   Furthermore, the trial court erred by entering a periodic payment 
schedule that does not assure full recovery.  In all other respects, the judgment is 
affirmed.  The case is remanded.  
 
 
 
 
 
 
 
 
______________________________________  
 
 
 
 
 
 
Richard B. Teitelman, Chief Justice  
 
Stith and Draper, JJ., and Midkiff,  
Sp.J., concur; Russell, J., concurs in 
part and dissents in part in separate  
opinion filed; Breckenridge and Price,  
JJ., concur in opinion of Russell, J.   
Fischer, J., not participating. 
 
 
SUPREME COURT OF MISSOURI 
en banc 
 
 
 
 
 
Deborah Watts as Next Friend for  
) 
Naython Kayne Watts, 
 
 
) 
 
 
 
 
 
 
) 
 
Appellant/Cross-Respondent, 
)   
 
 
 
 
 
 
) 
vs. 
 
 
 
 
 
) 
No. SC91867 
 
 
 
 
 
 
) 
Lester E. Cox Medical Centers d/b/a 
) 
Family Medical Care Center, Lester E.  ) 
Cox Medical Centers, 
 
 
) 
 
 
 
 
 
 
) 
 
Respondent,  
 
 
) 
 
 
 
 
 
 
) 
Melissa R. Herrman, M.D., Matthew P. )  
Green, D.O., and William S. Kelly,  
) 
M.D.,  
 
 
 
 
) 
 
 
 
 
 
 
) 
 
Respondents/Cross-Appellants. 
) 
 
OPINION CONCURRING IN PART AND DISSENTING IN PART 
The facts of this case are tragic.  The Watts family has suffered a misfortune that 
they will have to live with for many years to come.  Despite this unfortunate situation, it 
is this Court’s duty to analyze the constitutional validity of a statute regardless of how 
sympathetic the injury might be.  The legislature has passed a limitation on the amount of 
noneconomic damages an injured person can receive in a tort action.  Whether this is 
“good policy” is not a question for this Court.  This Court’s duty is to determine whether 
the provision at issue violates the Missouri Constitution.   As Chief Justice Roberts noted 
in National Federation of Independent Business v. Sebelius, courts have “the authority to 
interpret the law;” but “[courts] possess neither the expertise nor the prerogative to make 
policy judgments. Those decisions are entrusted to our … elected leaders ….” ___ U.S. 
___, 132 S.Ct. 2566, 2579 (2012).  “It is not [a court’s] job to protect the people from the 
consequences of their political choices.” Id.  This Court’s well-established precedent in 
Adams by and Through Adams v. Children’s Mercy Hospital, 832 S.W.2d 898, 907 (Mo. 
banc 1992), has previously determined that section 538.210 does not violate Missouri’s 
constitutional guarantee to a jury trial.  “Policy judgments” must be refrained from, and 
instead this Court must determine whether section 538.210 remains constitutional.  
Insofar as the majority opinion overrules this Court’s well-reasoned, longstanding 
precedent in Adams without persuasive justification, I respectfully dissent.  However, I 
concur in the majority opinion’s analysis of the interest rate and payment schedule issues.  
Adams is controlling in this case 
The majority holds that the noneconomic damages cap of section 538.210 violates 
the Missouri Constitution, overruling more than 20 years of precedent that authoritatively 
decided this issue in Adams.  The majority opinion reflects a wholesale departure from 
the unequivocal law of this state and leaps into a new era of law.  I do not agree with the 
2 
majority opinion’s disregard of stare decisis and, more importantly, of settled Missouri 
constitutional law.1 
 
Writing for the majority in Adams, Judge Robertson’s holding that section 538.210 
does not violate the Missouri Constitution’s right to a jury trial is dispositive in this case. 
832 S.W.2d at 907.  Adams reasoned that the role of the jury is fact-finding. Id.  This role 
requires the jury to determine liability and measure damages, both economic and 
noneconomic, as a result of liability. Id.  Once it has completed its fact-finding duty, it 
has completed its constitutional task. Id.  It is then the court’s duty to apply the law. Id.   
Section 538.210 establishes the substantive legal limits of a plaintiff’s damage 
remedy. Id.  As such, it is a matter of law, not fact. Id.  The court applies the law of 
section 538.210 only after the jury has completed its fact-finding duty. Id.   Because the 
court does not apply the law of section 538.210 until after the jury has performed its 
constitutional function, this statute does not violate the constitutional right to a trial by 
jury under article I, section 22(a) of the Missouri Constitution. Id.  Further, this Court 
noted in Adams that the legislature is permitted to abrogate a cause of action cognizable 
under the common law completely and, therefore, has the power to limit recovery in the 
same causes of action. Id.   
The majority’s reasons for departing from the holding in Adams are not persuasive 
because the issue of whether the legislature may abrogate the right to a trial by jury in a 
specific case is not essential to the constitutional validity of section 538.210.  The 
                                             
 
1 Just this year, this Court upheld section 538.210 with regard to statutorily created causes of 
action.  Sanders v. Ahmed, 364 S.W.3d 195, 204 (Mo. banc 2012). 
3 
majority opinion in this case assumes that the validity of the holding in Adams depends 
on the legislature’s authority to abrogate common law claims in toto. See also Klotz v. St. 
Anthony’s Med. Ctr., 311 S.W.3d 752, 773-74 (Mo. banc 2010) (Wolff, J., concurring).  
The holding in Adams, however, rested primarily on the fact that section 538.210 honors 
the right to a trial by jury. 832 S.W.2d at 907.  As long as the jury finds the facts and the 
trial court does not interfere with the jury’s fact-finding, the jury has served its 
constitutional task. Id.  The trial court’s application of the law to the facts after they have 
been found by the jury does not harm to the right to a trial by jury. Id. 
The majority’s distinction between the jury’s “constitutional task” and the 
“individual right” to a jury trial is meaningless and a distinction in name only.  This 
argument confuses the judicial process by which claims are determined with the 
substance of the claims themselves.  In general, the legislature is free to establish the 
substance of a claim, as, for instance, to allow or disallow punitive damages, but the 
Constitution guarantees a procedure for adjudicating that substantive claim.  Scott v. Blue 
Springs Ford Sales, Inc., 176 S.W.3d 140, 142 (Mo. banc 2005).  The right to jury trial 
does not limit the legislature's authority to determine what the elements of damages shall 
be.   
The jury serves no function other than providing an individual his right to a trial 
by jury.   As such, the jury’s “constitutional task” is to provide one with his or her 
“individual right” to a trial by jury.  Section 538.210 does not prevent the jury from 
assessing damages.  It is only after the jury assesses damages that the trial court applies 
4 
section 538.210.  When the jury performs its “constitutional task,” the plaintiff is 
afforded his or her “individual right” to a trial by jury.  
Section 538.210 did not violate the Missouri Constitution in Adams in 1992, and it 
does not violate the Constitution today.  I would uphold section 538.210 consistent with 
this Court’s 20 years of controlling precedent. 
Other states have agreed with this Court’s reasoning in Adams 
Although the majority opinion cites to other jurisdictions striking statutes limiting 
noneconomic damages, many states have held that such limitations do not violate their 
states’ respective right to a jury trial.  The majority opinion focuses on the “inviolate” 
language of Missouri’s Constitution, arguing that this language distinguishes Missouri’s 
right to a jury trial from its sister states’ jury trial guarantees. While I recognize that 
Missouri’s constitutional language differs from the Seventh Amendment, cases from 
jurisdictions with the same “inviolate” language as the Missouri Constitution have also 
found noneconomic damage caps constitutional under the same sound reasoning set forth 
in Adams. 
The Nebraska Constitution provides that “[t]he right of trial by jury shall remain 
inviolate ….” NEB. CONST. art. I, sec. 6.  The Supreme Court of Nebraska mirrored this 
Court’s reasoning in Adams in holding that a cap on total damages for medical 
malpractice actions did not violate its constitution’s right to a jury trial because “the trial 
court applies the remedy’s limitation only after the jury has fulfilled its factfinding 
function.” Gourley ex rel. Gourley v. Neb. Methodist Health Sys., 663 N.W.2d 43, 75 
(Neb. 2003).   
5 
Likewise, Idaho’s constitution provides that “[t]he right of trial by jury shall 
remain inviolate ….” IDAHO CONST. art. I, sec. 7.  The Supreme Court of Idaho analyzed 
the statutory cap imposed on noneconomic damages in the same way this Court did in 
Adams.  The Idaho court noted that the right to have a jury assess and award 
noneconomic damages existed at the adoption of the Idaho constitution, but that the 
statutory cap on noneconomic damages did not violate the right to a jury trial as it existed 
at that time.  Kirkland v. Blaine County Med. Ctr., 4 P.3d 1115, 1118-20 (Idaho 2000).  
Kirkland reasoned: “The jury is still allowed to act as the fact finder in personal injury 
cases. The statute simply limits the legal consequences of the jury’s finding.” Id. at 1120.  
The Idaho Supreme Court held that the legislative cap on noneconomic damages did not 
violate its constitution because “[t]he legal consequences and effect of a jury’s verdict are 
a matter for the legislature (by passing laws) and the courts (by applying those laws to the 
facts as found by the jury).” Id. 
In addition, Ohio’s constitution provides that “[t]he right of trial by jury shall be 
inviolate ….” OHIO CONST. art. I, sec. 5.  The Supreme Court of Ohio upheld a statutory 
noneconomic damage cap as constitutional in line with other courts addressing damage 
caps under same constitutional language.  Arbino v. Johnson & Johnson, 880 N.E.2d 420, 
430-32 (Ohio 2007).  Arbino reasoned that the Ohio constitution’s guarantee to a jury 
trial applied to those causes of action for which the right existed at common law when the 
constitution was adopted, and tort actions were such cases. Id. at 430-31.  Mirroring the 
reasoning in Adams, Gourley, and Kirkland, the Supreme Court of Ohio found that the 
right to a trial by jury “protects a plaintiff’s right to have a jury determine all issues of 
6 
fact in his or her case.” Id. at 431.  The court continued: “So long as the fact-finding 
process is not intruded upon and the resulting findings of fact are not ignored or replaced 
by another body’s findings, awards may be altered as a matter of law.” Id.  The statutory 
noneconomic damage cap provided that “[c]ourts must simply apply the limits as a matter 
of law to the facts found by the jury; they do not alter the findings of facts themselves, 
thus avoiding constitutional conflicts.”  Id. at 432. 
 
Further, Maryland’s constitution provides that the right to a trial by jury “shall be 
inviolably preserved.” MD. CONST. Declaration of Rights, art. 23.  In accord with other 
cases involving constitutional guarantees that the right of a jury trial shall remain 
“inviolate,” the Supreme Court of Maryland upheld the statutory cap on noneconomic 
damages. Murphy v. Edwards, 601 A.2d 102, 118 (Md. 1992).  Maryland’s constitution 
also “preserves unimpaired the ultimate historical right [to a jury trial in civil cases] as it 
existed at common law.” Id. at 116 (internal quotation marks omitted).  The Maryland 
Supreme Court reasoned, in line with the cases discussed above, that “the jury trial right 
in civil cases relates to ‘issues of fact’ in legal actions. It does not extend to issues of law 
….” Id.  In light of that analysis, Murphy held:  
[The statutory cap on noneconomic damages] fully preserves the right of 
having a jury resolve the factual issues with regard to the amount of 
noneconomic damages. Neither the [statutory] limit on recovery nor the 
provision that the jury shall not be informed of the limit, interferes with the 
jury's proper role and its ability to resolve the factual issues which are 
pertinent to the cause of action. 
 
Id. at 117.  
7 
The majority opinion is also critical of Etheridge v. Med. Ctr. Hosps., 376 S.E.2d 
525 (Va. 1989).  The argument is that, because the Virginia constitution contains 
different language than the Missouri Constitution in its guarantee of a jury trial, then the 
Virginia right to a jury trial is somehow less protective of the right.  This is simply 
incorrect.  Although the majority opinion is correct in noting the different language in the 
two constitutions, Virginia has held that its guarantee to a jury trial secures those rights 
“that existed at common law,” as does the Missouri Constitution. Id. at 529; State ex rel. 
Diehl v. O’Malley, 95 S.W.3d 82, 85-89 (Mo. banc 2003) (holding that the right to a jury 
trial attaches to actions that existed at common law or actions that are analogous to 
actions that existed at common law).  In light of the Virginia Supreme Court’s 
interpretation of its own constitution, there is no ground for this Court to distinguish the 
right to a jury trial in Virginia from the right to a jury trial in Missouri with regard to 
statutory damage caps.  Although the constitutional language contains superficial 
differences, the substantive right is essentially the same.  This is evident from the 
Virginia Supreme Court’s analysis in Etheridge.  The court reasoned that “[w]ithout 
question, the jury’s fact-finding function extends to the assessment of damages.” 
Etheridge, 376 S.E.2d at 529.  “Once the jury has ascertained the facts and assessed the 
damages, however, the constitutional mandate is satisfied.” Id.  “Thereafter, it is the duty 
of the court to apply the law to the facts.” Id.  Just as other courts with constitutional 
language identical to Missouri’s jury trial guarantee have held, the Virginia Supreme 
Court held: 
8 
A trial court applies the remedy's limitation only after the jury has fulfilled 
its fact-finding function. Thus, [the statutory noneconomic damage cap] 
does not infringe upon the right to a jury trial because the section does not 
apply until after a jury has completed its assigned function in the judicial 
process. 
 
Id.  The statutory damage cap was held not to infringe on the plaintiff’s right to a trial by 
jury. Id.   
 
In addition to the cases that mirror Adams’ analysis regarding the “inviolate” right 
to a jury trial, there are other jurisdictions in which such caps are upheld under jury trial 
guarantees that do not contain “inviolate” language under the same rationale as Adams. 
See Boyd v. Bulala, 877 F.2d 1191, 1196 (4th Cir. 1989) (“[O]nce the jury has made its 
findings of fact with respect to damages, it has fulfilled its constitutional function; it may 
not also mandate compensation as a matter of law.”); Evans ex rel. Kutch v. State 56 P.3d 
1046, 1051 (Alaska 2002) (“The decision to place a cap on damages awarded is a policy 
choice and not a re-examination of the factual question of damages determined by the 
jury.”); Wright v. Colleton County Sch. Dist., 391 S.E.2d 564, 569-70 (S.C. 1990) (“A 
remedy is a matter of law, not a matter of fact. Although a party has the right to have a 
jury assess his damages, he has no right to have a jury dictate through an award, the legal 
consequences of its assessments.”); Judd v. Dregza, 103 P.3d 135, 144 (Utah 2004) (“The 
damage cap enacted by the legislature represents law, similar to an element of a claim to 
which the trial court must comport the jury’s factual determinations.”).  
Further, other states that provide in their constitutions that the right to a jury trial is 
“inviolate” have upheld statutory caps on recoverable damages under different analysis.  
See Samsel v. Wheeler Transp. Servs., Inc. 789 P.2d 541 (Kan. 1990); Johnson v. St. 
9 
10 
                                             
Vincent Hosp., Inc., 404 N.E.2d 585 (Ind. 1980) (overruled on other grounds); Fein v. 
Permanente Med. Group, 695 P.2d 665 (Cal. 1985).2   
Other cases in jurisdictions without “inviolate” constitutional language have 
upheld similar caps under different analysis as well. See Peters v. Saft, 597 A.2d 50 (Me. 
1991); Robinson v. Charleston Area Med. Ctr., Inc. 414 S.E.2d 877 (W.Va. 1991); Davis 
v. Omitowoju, 883 F.2d 1155 (3rd Cir. 1989). 
Not only does stare decisis direct that this Court adhere to its previous holding in 
Adams, but Adams is also squarely in line with other jurisdictions that have addressed the 
constitutional validity of statutory caps on noneconomic damages.  I would uphold the 
statutory cap on noneconomic damages in section 538.210.  
                      
 ______________________________ 
Mary R. Russell, Judge                      
 
 
2 Fein did not expressly address California’s right to a jury trial.