Case Name: FLORIDA PATIENT'S COMPENSATION FUND, et al., Appellants v. Susan Ann VON STETINA, etc., et al., Appellees
Court: Florida Supreme Court
Jurisdiction: Florida
Decision Date: 1985-05-16
Citations: 474 So. 2d 783
Docket Number: Nos. 64237, 64251 and 64252
Parties: FLORIDA PATIENT’S COMPENSATION FUND, et al., Appellants v. Susan Ann VON STETINA, etc., et al., Appellees.
Judges: ALDERMAN, McDONALD, EHRLICH and SHAW, JJ., concur.
Reporter: Southern Reporter, Second Series
Volume: 474
Pages: 783–796

Head Matter:
FLORIDA PATIENT’S COMPENSATION FUND, et al., Appellants v. Susan Ann VON STETINA, etc., et al., Appellees.
Nos. 64237, 64251 and 64252.
Supreme Court of Florida.
May 16, 1985.
Rehearing Denied Aug. 29, 1985.
Talbot D’Alemberte, Charles W. Eh-rhardt, Richard B. Collins of Perkins and Collins, Tallahassee and Jeffrey B. Crockett and Samuel J. Dubbin of Steel, Hector and Davis, Miami, for Florida Patient’s Compensation Fund.
William H. Lefkowitz and David M. Or-shefsky of Ruden, Barnett, McClosky, Schuster and Russell, Fort Lauderdale, Steven R. Berger and Bernard and Mauro, Miami, for Florida Medical Center.
Sheldon J. Schlesinger, P.A., Fort Laud-erdale, and Joel D. Eaton of Podhurst, Or-seck, Parks, Josefsberg, Eaton, Meadow and Olin, Miami, for appellees.
Bruce Culpepper and F. Townsend Hawkes of Culpepper, Beatty and Turner, Tallahassee, and Richard A. Sherman, Fort Lauderdale, amicus curiae for The Florida Medical Malpractice Joint Underwriting Ass’n.
R.J. Beckham of Beckham and McAliley, Jacksonville, amicus curiae for John E. Mathews and Gwendolyn G. Mathews.
James E. Tribble and Diane H. Tutt of Blackwell Walker Gray Powers Flick & Hoehl, Miami, amicus curiae for Florida Defense Lawyers Ass’n.

Opinion:
PER CURIAM.
This is an appeal from Florida Medical Center, Inc. v. Von Stetina, 436 So.2d 1022 (Fla. 4th DCA 1983), in which the Fourth District Court of Appeal affirmed a $12.47 million medical malpractice verdict and held unconstitutional sections 768.-54(2)(b), 768.54(3)(e)3, and 768.51, Florida Statutes (1981), which relate to hospital liability limitation and the method to be used by the Florida Patient's Compensation Fund ("Fund") in paying final judgments. The district court upheld the constitutionality of section 768.56, Florida Statutes (1981), which authorizes the trial court to award reasonable attorney's fees to the prevailing party in medical malpractice cases, but reduced the fee awarded to the appellees' attorney from $4.4 million to $1.5 million. We have jurisdiction, article V, section 3(b)(1) and (3), Florida Constitution. We reverse the decision of the district court holding the subject statutes unconstitutional. We also vacate the judgment and remand for a new trial.
On November 26, 1980, Von Stetina, then 27 years of age, was injured in an automobile accident. She was taken to the emergency room at Florida Medical Center, where doctors determined that she had sustained abdominal injuries and a fractured femur and wrist, but no serious head or neurological injuries. Shortly after she arrived at the medical center, a surgeon removed her spleen and portions of her liver and pancreas. At trial, the surgeon testified that Von Stetina came through the operation "very nicely" and that the prognosis for her recovery was good.
Following the operation, Von Stetina was placed in the hospital's intensive care unit and connected to a mechanical ventilator to assist her in breathing. She was taken off the ventilator the next day because she could breathe adequately on her own. Although heavily sedated, she was able to communicate with her family and nurses. On December 1, she underwent trauma-induced respiratory distress, a condition which is not uncommon for post-surgery patients. She was then placed on a ventilator which is designed to breathe for the patient, rather than to merely assist the patient in breathing. A muscle-paralyzing drug was administered to temporarily paralyze Von Stetina so as to avoid malfunctions, patient-machine disconnections, and air supply interruptions which may occur when a patient "fights" this type of ventilator. Testimony indicated that Von Steti-na needed a dose of the drug every forty-five minutes to ensure her compatability with the ventilator. Von Stetina's hospital chart shows that on the morning of December 3, the final dosage of the muscle-paralyzing drug was administered at 1:30 a.m. No notations were recorded in her chart after 2:00 a.m. At 3:28 a.m., while obtaining medication for another patient in the intensive care unit, a nurse observed that Von Stetina's cardiac monitor revealed a dangerously low heart rate. She immediately initiated a "code blue" emergency process during which Von Stetina's heartbeat was restored. The evidence disclosed that Von Stetina suffered severe brain damage because of an interruption of her oxygen supply. The hospital's chief of staff testified that tests reflected an oxygen loss occurred during the critical period of time, indicating there had in fact been a respirator malfunction or disconnection. The hospital presented evidence that Von Stetina's brain damage could have been caused by respiratory distress rather than by a respirator malfunction and that Von Stetina lacks capacity to appreciate the tragedy that has befallen her.
Von Stetina offered evidence that she feels pain and reacts to it with facial grimaces and contortions and by crying out, that she recognizes and reacts to people, and that she responds to music, affection, and the touch of a human hand. Von Steti-na also introduced into evidence, over defense counsel's objection, a nurses' journal article entitled "Just Breathing," which had been written by a nurse and was part of the training materials used in an in-service program offered by the hospital. The article, purportedly based on experiences of ventilator patients, evokes the mental trauma of total dependence on a ventilator and paralysis required for effective ventilation.
After sustaining brain damage, Von Ste-tina was blinded in one eye by the hospital's failure to keep the eye lubricated properly and taped shut. In addition, her partially healed leg was refractured without explanation. The evidence is unrefuted that these later injuries were caused by substandard care. The evidence further establishes that Von Stetina has a life expectancy of 40 years, but that her quality of life can be best enhanced through round-the-clock nursing care.
The jury found that the negligence of the hospital caused Von Stetina's condition and, in a special verdict, determined the component damages to be as follows:
Past medical and nursing care $ 125,000
Future medical and nursing care 7,536,000
Past loss of earnings 16,250
Future loss of earnings 663,000
Past pain and suffering 133,000
Future pain and suffering 4,000,000
Total $12,473,250
Although the hospital continues to contest the validity of the jury's determination of liability, the Fund does not, conceding that evidence of negligence was sufficient for the jury to find the hospital liable.
In entering judgment in accordance with the verdict, the trial court held unconstitutional the portion of section 768.54(2)(b) that modifies the law on joint and several liability and shifts to the Fund the obligation to pay the portion of any judgment that exceeds $100,000. The court also found unconstitutional section 768.54(3)(e)3, as it existed in 1981, which restricted the Fund's obligation to pay "not more than $100,000 per person per year until the claim has been paid in full," and refused to apply the 1982 amendment to that section, which eliminates the $100,000 maximum pay-out. The trial judge found the above sections unconstitutional on the grounds they attempt to limit the court's inherent power to enforce judgments and violate both the equal protection and due process clauses of the Florida and United States Constitutions. The trial judge also found unconstitutional section 768.51, Florida Statutes (1981), which provides for the Fund to compensate claimants whose future losses exceed $200,000 in a manner to be determined by the court, because it "im-permissibly encroaches upon the inherent power of this court to enter and enforce its judgments," and "arbitrarily and invidiously discriminates against medical malpractice victims who have suffered damages in excess of $200,000."
In considering the attorney's fee for Von Stetina's counsel, the trial court upheld the constitutionality of section 768.56, Florida Statutes (1981), which provides for the prevailing party to be awarded attorney's fees in malpractice actions. Von Stetina's counsel had contracted to represent her for a forty percent contingency fee. In setting the fee at $4.4 million, the trial judge stated that he relied heavily upon the contingency factor. Two expert witnesses produced by Von Stetina testified that fees of $5 million and $4,988 million would be appropriate, the latter figure equalling forty percent of the amount of the verdict.
The district court of appeal agreed with the trial court that sections 768.54(2)(b) and (3)(e)3 and 768.51, Florida Statutes (1981), are unconstitutional, and adopted to a large extent the trial court's reasoning. The district court found that the nurses' journal article was erroneously admitted because the appellant did not lay a predicate that Von Stetina or any other patient had actually experienced the thoughts and emotions depicted under similar circumstances. It found the evidence to be cumulative and concluded that the error was harmless. The district court also refused to set aside the jury award as excessive, recognizing that it was "admittedly at the maximum of any reasonable range," but concluding that "[fjorty years' imprisonment within a helpless body racked with pain and requiring nearly $200,000 worth of medical care each year can hardly be equalled by all the tortures of the damned." 436 So.2d at 1024.
The district court also affirmed the trial court's holding that section 768.56 was constitutional, but concluded that the trial court's award of a $4.4 million attorney's fee was an "abuse of discretion under the facts," determining that the trial judge had accorded too much weight to an appropriate contingency percentage, while giving only limited consideration to the time expended by counsel in obtaining this result. Id. at 1032. The district court reduced the fee from $4.4 million to $1.5 million.
The issues presented to this Court on mandatory review were (1) whether the statutory scheme providing for the Fund to pay judgments for health care providers and physicians is constitutional under the provisions of section 768.54(2)(b), section 768.51, and section 768.54(3)(e)3, either as enacted in 1976 or as amended in 1982; (2) whether it constituted prejudicial error for the trial court to admit into evidence the article utilized as part of the training materials for the intensive care unit nurses in the appellant hospital; (3) whether the damages awarded for pain and suffering in this case are excessive; and (4) whether section 768.56, which directs the court to set reasonable attorney's fees for the prevailing party, is constitutional, and, if so, whether the attorney's fee awarded in this case is reasonable.
Part I: Constitutionality of Florida Patient's Compensation Fund Pay-Out Provisions.
Before evaluating the constitutionality of sections 768.54(2)(b), 768.54(3)(e)3, and 768.-51, we must first determine whether section 768.54(3)(e)3 as enacted in 1976, or as amended in 1982, is applicable to this case. The original enactment provides for the Fund to pay, in place of a health care provider, the portion of any judgment which exceeds $100,000, but limits the payment to no more than $100,000 per person per year until the claim has been paid in full. Assuming the 1976 provision is applicable, it is clear that the statute would prohibit the Fund from paying the full amount of the annual medical expenses of Von Stetina, determined by the jury to be $188,400. In 1982, while this cause was pending in the trial court, the "cap" on payments was eliminated by an amendment to section 768.54(3)(e)3. The amendment did not become effective until two months after the entry of the trial court's judgment, but it has been in effect while this cause has been pending on appeal.
The Fund contends that an appellate court must apply the most recent version of the statute when it is the law in effect at the time of the appellate court's final decision. The district court rejected that view, finding that the statutory change affects a substantive matter and that its application to the present case constitutes an impermissible retroactive application.
We disagree with the district court. The judgment awarded in favor of Von Stetina is not final until the case has been disposed of on appeal. An appellate court is generally required to apply the law in effect at the time of its decision. See Hendeles v. Sanford Auto Auction, Inc., 364 So.2d 467 (Fla.1978); Florida East Coast Railway v. Rouse, 194 So.2d 260 (Fla.1966); Eastern Air Lines, Inc. v. Gellert, 438 So.2d 923 (Fla. 3d DCA 1983); Department of Administration v. Brown, 334 So.2d 355 (Fla. 1st DCA 1976). In City of Lakeland v. Catinella, 129 So.2d 133 (Fla.1961), this Court said:
Remedial statutes or statutes relating to remedies or modes of procedure, which do not create new or take away vested rights, but only operate in furtherance of the remedy or confirmation of rights already existing, do not come within the legal conception of a retrospective law, or the general rule against retrospective operation of statutes.
Id. at 136 (citing Cunningham v. State Plant Board, 112 So.2d 905 (Fla. 2d DCA), cert. denied, 115 So.2d 701 (Fla.1959)). We accept the Fund's view that the 1982 amendment to section 768.54 is remedial in nature. The amendment does not alter the size of the judgment in favor of Von Steti-na; rather, it prescribes the method by which the judgment is to be paid. We find that the statute simply changes the form of the enforcement and does not substantially impair any existing rights. See Village of El Portal v. City of Miami Shores, 362 So.2d 275 (Fla.1978).
Having determined that we should apply the 1982 version of section 768.-54(3)(e)3, we will proceed to consider its constitutionality along with the constitutionality of sections 768.54(2)(b) and 768.51, Florida Statutes (1981). Initially, however, the reason for the creation of the Fund must be fully understood. In 1975, the Florida Legislature instituted the Fund as a non-profit entity to provide medical malpractice protection to the physicians and hospitals who join it, as well as a method of payment to medical malpractice plaintiffs. See ch. 75-9, Laws of Fla. The Fund provides a statutory scheme of pooling the risk of losses and placing major losses in the entity that can best spread the risk of loss as well as control the conduct of those at fault. Department of Insurance v. Southeast Volusia Hospital District, 438 So.2d 815 (Fla.1983), appeal dismissed, — U.S. -, 104 S.Ct. 1673, 80 L.Ed.2d 149 (1984). In its preamble to the 1976 amendment, the legislature summarized its public policy findings with respect to the need for the enactment. It reads, in part, as follows:
WHEREAS, despite the responsive and responsible actions of the 1975 session of the legislature, professional liability insurance premiums for Florida physicians have continued to rise and . such insurance, even at exorbitant rates, is becoming virtually unavailable in the voluntary private sector, and . this insurance crisis threatens the quality of health care services in Florida . and . this crisis also poses a dire threat to the continuing availability of health care in our state . and . our present tort law/liability insurance system for medical malpractice will eventually break down . [and] fundamental reforms of said tort law/liability insurance system must be undertaken, and . the continuing crisis proportions of this compelling social problem demand immediate and dramatic legislative action....
Ch. 76-260, Laws of Fla. See also ch. 75-9, Laws of Fla.
Von Stetina contends that the legislature cannot constitutionally limit the liability of a health care provider to $100,000 and transfer the responsibility to pay the portion of a judgment which is in excess of $100,000 from the health care provider to the Fund. In addition, she argues the statutory scheme violates the separation of powers by interfering with the authority of the courts to enforce their own judgments. We disagree. The Florida Patient's Compensation Fund provides health care providers with medical malpractice liability coverage for the benefit of both the health care providers and those members of the public who become victims of medical malpractice. In Southeast Volusia Hospital District, we upheld the concept of the Fund and its assessment mechanism. We find the statutory scheme does not deny plaintiffs recovery of judgments, but in fact is designed, in part, to ensure that sufficient funds exist to pay substantial judgments to medical malpractice victims. The scheme that makes the Fund party to a medical malpractice action and responsible for portions of awards in excess of $100,000 does not substantially violate or change any of the plaintiffs vested rights. We caution, however, that we do not address in this action the constitutional right of a plaintiff to levy against a health care provider when the Fund is fiscally incapable of or otherwise prohibited from paying validly entered judgments within a reasonable time because of inadequate rates and assessments.
Von Stetina also attacks as unconstitutional section 768.51, which provides for the payment of future medical expenses and future lost wages as they are actually incurred. We find that section 768.51 establishes a reasonable means for medical malpractice victims to recover future losses. Traditionally, future damages resulting from tort liability have been compensated by means of a lump sum judgment. For many years, however, commentators have suggested that legislation providing for periodic payments of future damages in personal injury awards would benefit both plaintiffs and defendants. See National Conference of Commissioners on Uniform State Laws, Model Periodic Payment of Judgments Act (1980); Henderson, Periodic Payments of Bodily Injury Awards, 66 A.B.A.J. 734 (1980).
We find the legislation at issue does not implicate a fundamental right or suspect classification. See Pinillos v. Cedars of Lebanon Hospital Corp., 403 So.2d 365 (Fla.1981); Woods v. Holy Cross Hospital, 591 F.2d 1164 (5th Cir.1979). Cf. Carson v. Maurer, 120 N.H. 925, 424 A.2d 825 (1980). We strongly adhere to the view that "the judiciary may not sit as a superlegislature to judge the wisdom or desirability of legislative policy determinations made in areas that neither affect fundamental rights nor proceed along suspect lines." City of New Orleans v. Dukes, 427 U.S. 297, 303, 96 S.Ct. 2513, 2516, 49 L.Ed.2d 511 (1976). So long as the legislative measure is rationally related to legitimate state interests, we must not substitute our judgment for that of the legislature with respect to the need for, or wisdom of, a legislative enactment. See State v. Bales, 343 So.2d 9 (Fla.1977). We conclude that the legislature could reasonably find that the increasing costs of medical malpractice insurance posed a threat to the continued availability and adequacy of health care services, and that the public health could be protected by the enactment of the subject measures, which were designed to reform the medical malpractice insurance system. Cf Pinillos, 403 So.2d at 368. The legislature has designated a source to pay medical malpractice judgments and has created a system of paying future damages. It has not modified the dollar amount of medical malpractice judgments that can be rendered. In our view, such action is within the constitutional prerogative of the legislature. We find nothing in the transfer of liability provision or the periodic pay-out provisions as applied to this case that constitutionally invalidates the statutory scheme. We specifically uphold the constitutionality of sections 768.54(2)(b), 768.54(3)(e)3, and 768.51, Florida Statutes (1981).
Part II: Admissibility of Nurse Training Materials
The Fund and the hospital contend that the nurses' journal article was erroneously admitted by the trial judge because it was fictional, it was not presented by the author, and it was not shown that the thoughts occurred in the mind of Von Steti-na or any other patient. They assert that the district court of appeal correctly found that the admission of the article was error but incorrectly concluded that the error was harmless because it was "cumulative" in that "[tjhere was so much other deeply moving evidence." 436 So.2d at 1033. Appellants argue that it resulted in a preju-. dicial impact on the damages awarded in this case.
The short story read into the record and submitted in evidence to the jury was inad missible because it was not relevant to a material issue in the litigation.
Nothing in the story focuses on the actions of the attendant nurse in terms of the nurse's function. Nothing in the story establishes a standard of care or dictates a procedure for attending ventilated patients. Rather, it speaks of a conscious, ventilated patient's perception of the experience and the helplessness involved. The only "training" this short story would efficate is affective training — development of empathy. Plaintiff's counsel himself so characterized it.
A cause of action does not exist for lack of empathy except, perhaps, for negligent or intentional infliction of emotional distress. But even assuming a cause of action in medical malpractice could be brought for lack of empathy in violation of the standard of care required, this case was not predicated on that theory. In very carefully documented evidence elicited from a series of witnesses, plaintiff's counsel proved that every staff member available at the time of Von Stetina's mishap was actively involved in the delivery of necessary care to patients who were more acutely in need than Von Stetina appeared to be at the last recorded vital-sign monitoring before the event. There was simply no attempt to prove that the nurses callously or even negligently ignored the victim. Plaintiff proved that the nurses could not be two places at once, regardless of the degree of care and concern they felt.
Finally, plaintiff's attorney elicited from every nurse on duty that night her background and training. Not one had received training at Florida Medical Center. There is no evidence in the record that any of the nurses staffing the ICU that night were ever exposed to the document.
The story did not establish a technical standard of care by which the nurses' actions could be measured. The evidence presented showed that the nurses did not neglect Von Stetina out of lack of empathy, but, if at all, from understaffing which created a demand for their immediate services elsewhere. The relevance of the story as a training tool is not established. Because it was irrelevant, it was inadmissible.
Further, we cannot find this to be harmless error. As plaintiff's counsel brought out, the intended effect of the story was to touch the emotions of the nurses so as to create empathy. This is unarguably the effect its admission into evidence was intended to create in the jurors. The story essentially puts the reader in the patient's situation and evokes from the reader or listener the terror, pain and helplessness felt by a patient. However, this is the trauma caused by adequate and entirely proper treatment. It is not pain and suffering for which a patient may recover money damages. Neither does the emotional response to perceived pain and terror add to the jury's ability to weigh the disputed facts in determining liability.
The jurors were presented with evidence designed to arouse emotions and they were assured that this evidence was relevant and material to their determination of the issues before them. The jurors had no reason to disregard their empathetic response and we must assume that that response was reflected to some extent in the verdict rendered. Mere sympathy cannot sustain a judgment. A juror is charged with the duty to weigh evidence and to find fact. The jury system should not function on emotion, but on logic. The introduction of this highly emotional, irrelevant document must have colored the jury's approach to the evidence. As such the admission of the document cannot have been harmless error. The judgment must be vacated and petitioners granted a new trial.
Part III. Damage Award
Because we vacate the judgment in its entirety, we need not address the issue of damages at this time.
Part IV. Attorney's Fees
We have recently addressed the issue of attorneys' fees and the constitutionality of the underlying statute in Florida Patient's Compensation Fund v. Rowe, 472 So.2d 1145 (Fla. 1985), which will control the con sideration of the award of attorneys' fees, if any, in further proceedings.
The decision of the district court, is reversed and the ease is remanded for a new trial.
It is so ordered.
ALDERMAN, McDONALD, EHRLICH and SHAW, JJ., concur.
BOYD, C.J., concurs in part and dissents in part with an opinion.
OVERTON, J., concurs in part and dissents in part with an opinion, in which ADKINS, J., concurs.
EHRLICH, J., participates in parts I, II & III with an opinion.
.The applicable portion of the 1976 statute is as follows:
3. A person who has recovered a final judgment or a settlement approved by the Fund against a health care provider who is covered by the Fund may file a claim with the Fund to recover that portion of such judgment or settlement which is in excess of $100,000 or the amount of the health care provider's basic coverage, if greater, as set forth in paragraph (2)(b). In the event an account for a given year incurs liability exceeding $100,000 to all persons under a single occurrence, the persons recovering shall be paid from the account at a rate not more than $100,000 per person per year until the claim has been paid in full, except that court costs and reasonable attorney's fees shall be paid in one lump sum within 90 days after the settlement or judgment is rendered. Such fees shall not reduce the amount of the annual award.
.The amended provision reads as follows:
3.A person who has recovered a final judgment against the Fund or against a health care provider who is covered by the Fund may file a claim with the Fund to recover that portion of such judgment which is in excess of the applicable amount set forth in paragraph (2)(f) or the amount of the health care provider's basic coverage, if greater, as set forth in paragraph (2)(b). The amount of liability of the Fund under a judgment, including court costs, reasonable attorney's fees, and interest, shall be paid in a lump sum, except that any claims for future special damages, as set forth in s. 768.48(l)(a) and (b), shall be paid periodically as they are incurred by the claimant. If a claimant dies while receiving periodic payments, payment for future medical expenses shall cease, but payment for future wage loss, if any, shall continue at a rate of not more than $100,000 per year.
. A medical malpractice periodic payment provision similar to but apparently more restrictive than Florida's was recently approved by the Supreme Court of California in American Bank & Trust Co. v. Community Hospital, Inc., 36 Cal.3d 359, 683 P.2d 670, 204 Cal.Rptr. 671 (1984).