Case Name: GALEN OF FLORIDA, INC., et al., Petitioners, v. Lori Ann BRANIFF, et al., Respondents; Robert BAZLEY, M.D., Petitioner, v. Lori Ann BRANIFF, et al., Respondents
Court: Florida Supreme Court
Jurisdiction: Florida
Decision Date: 1997-05-01
Citations: 696 So. 2d 308
Docket Number: Nos. 86485, 86486
Parties: GALEN OF FLORIDA, INC., et al., Petitioners, v. Lori Ann BRANIFF, et al., Respondents. Robert BAZLEY, M.D., Petitioner, v. Lori Ann BRANIFF, et al., Respondents.
Judges: SHAW, HARDING, WELLS and ANSTEAD, JJ., concur.
Reporter: Southern Reporter, Second Series
Volume: 696
Pages: 308–314

Head Matter:
GALEN OF FLORIDA, INC., et al., Petitioners, v. Lori Ann BRANIFF, et al., Respondents. Robert BAZLEY, M.D., Petitioner, v. Lori Ann BRANIFF, et al., Respondents.
Nos. 86485, 86486.
Supreme Court of Florida.
May 1, 1997.
Rehearing Denied July 1, 1997.
Robert E. Broach, Alan K. Ragan and James C. Rinaman, Jr. of Marks, Gray, Con-roy & Gibbs, P.A., Jacksonville, and Jack W. Shaw, Jr. and Michael J. Obringer of Brown, Obringer, Shaw, Beardsley & DeCandio, Jacksonville, for Petitioners.
F. Shields McManus of Gary, Williams, Parenti, Finney, Lewis, McManus, Watson & Sperando, Stuart, and Edna L. Caruso of Caruso, Burlington, Bohn & Compiani, P.A, West Palm Beach, for Respondents.
Dock A. Blanchard of Blanchard, Merriam, Adel & Kirkland, P.A., Ocala, for The Academy of Florida Trial Lawyers, Amicus Curiae.
Vincent J. Rio, III, Stephen E. Day, Raymond L. Roebuck and P. Heath Brockwell of Taylor, Day & Rio, Jacksonville, for the Florida Statutory Teaching Hospital Council, Association of Voluntary Hospitals of Florida, Florida Hospital Association, and Florida Medical Association, Amici Curiae.
Bruce S. Rogow and Beverly A. Pohl of Bruce S. Rogow, P.A., Fort Lauderdale, and Phillip Taylor of Taylor & Swope, Tampa, for Jaimes McKaughan and Darlene McKau-ghan, individually and on behalf of their son Michael McKaughan, Amici Curiae.
Joel D. Eaton of Podhurst, Orseck, Josefs-berg, Eaton, Meadow, Olin & Perwin, P.A, Miami, for Athey and Sierra, Amicus Curiae.

Opinion:
KOGAN, Chief Justice.
We have for consideration the following question certified by the First District Court of Appeal to be of great public importance:
WHETHER SECTION 766.316, FLORIDA STATUTES (1993), REQUIRES THAT HEALTH CARE PROVIDERS GIVE THEIR OBSTETRICAL PATIENTS PRE-DELIVERY NOTICE OF THEIR PARTICIPATION IN THE FLORIDA BIRTH RELATED NEUROLOGICAL INJURY COMPENSATION PLAN AS A CONDITION PRECEDENT TO THE PROVIDERS' INVOKING NICA AS THE PATIENTS' EXCLUSIVE REMEDY?
Braniff v. Galen of Florida, Inc., 669 So.2d 1051, 1053 (Fla. 1st DCA 1995). We have jurisdiction. Art. V, § 3(b)(4), Fla. Const.
In answer to the certified question, we hold that as a condition precedent to invoking the Florida Birth-Related Neurological Injury Compensation Plan as a patient's exclusive remedy, health care providers must, when practicable, give their obstetrical patients notice of their participation in the plan a reasonable time prior to delivery.
The Braniffs brought a medical malpractice action against the obstetrician who delivered their daughter and the hospital where the delivery took place. The Braniffs alleged that their daughter suffered severe neurological impairment and permanent brain damage as a result of the defendants' negligence during the delivery. The defendants responded with a motion to dismiss, claiming that the Braniffs were limited to an administrative remedy under Florida's Birth-Related Neurological Injury Compensation Plan (NICA plan), sections 766.301-766.316, Florida Statutes (1993).
The Braniffs took the position that their civil suit was not precluded because the defendants had failed to comply with the NICA plan's notice provision, section 766.316, Florida Statutes (1993). The Braniffs maintained that as a condition precedent to asserting NICA exclusivity, section 766.316 required the defendants to give Mrs. Braniff notice of their participation in the plan prior to delivery. Thus, since Mrs. Braniff was not given the requisite pre-delivery notice, she was not limited to NICA's administrative remedy. The defendants contended that they had notified Mrs. Braniff of their participation in the NICA plan prior to delivery. They further maintained that pre-delivery notice is not required under the plan nor is exclusivity of the NICA remedy conditioned on pre-delivery notice.
The trial court dismissed the civil action, concluding that section 766.316 does not require pre-delivery notice. The First District reversed, holding that pre-delivery notice is-a condition precedent to exclusivity under the plan and that the factual dispute over whether notice was given in this case should be resolved by the jury. We are in general agreement with the district court.
Section 766.316 provides in pertinent part:
Each hospital with a participating physician on its staff and each participating physician . under the Florida Birth-Related Neurological Injury Compensation Plan shall provide notice to the obstetrical patients thereof as to the limited no-fault alternative for birth-related neurological injuries. Such notice shall be provided on forms furnished by the association and shall include a clear and concise explanation of a patient's rights and limitations under the plan.
Without exception the district courts of appeal that have addressed the issue have read section 766.316 to require pre-delivery notice. Braniff; Siravo v. Florida Birth-Related Neurological Injury Compensation Ass'n, 667 So.2d 971 (Fla. 4th DCA 1996); Bradford v. Florida Birth-Related Neurological Injury Compensation Ass'n, 667 So.2d 401 (Fla. 4th DCA 1995); Behan v. Florida Birth-Related Neurological Injury Compensation Ass'n, 664 So.2d 1173 (Fla. 4th DCA 1995); Mills v. North Broward Hosp. Dist., 664 So.2d 65 (Fla. 4th DCA 1995); Turner v. Hubrich, 656 So.2d 970 (Fla. 5th DCA 1995).
We agree with the district courts that the only logical reading of the statute is that before an obstetrical patient's remedy is limited by the NICA plan, the patient must be given pre-delivery notice of the health care provider's participation in the plan. Section 766.316 requires that obstetrical patients be given notice "as to the limited no-fault alternative for birth-related neurological injuries." That notice must "include a clear and concise explanation of a patient's rights and limitations under the plan." § 766.316. This language makes clear that the purpose of the notice is to give an obstetrical patient an opportunity to make an informed choice between using a health care provider participating in the NICA plan or using a provider who is not a participant and thereby preserving her civil remedies. Turner v. Hubrich, 656 So.2d 970, 971 (Fla. 5th DCA 1995). In order to effectuate this purpose a NICA participant must give a patient notice of the "no-fault alternative for birth-related neurological injuries" a reasonable time prior to delivery, when practicable.
Our construction of the statute is supported by its legislative history. Florida's Birth-Related Neurological Injury Compensation Plan was proposed by the 1987 Academic Task Force for Review of the Insurance and Tort Systems. In its November 6, 1987, report, the Task Force recommended adoption of a no-fault compensation plan for birth-related neurological injuries similar to the then newly enacted Virginia plan (1987 Va. Acts Ch. 540). Academic Task Force for Review of the Insurance and Tort Systems, Medical Malpractice Recommendations 31 (Nov. 6, 1987) (hereinafter Task Force Report).
However, the Task Force was concerned that the Virginia legislation did not contain a notice requirement and recommended that the Florida plan contain such a requirement. The Task Force believed that notice was necessary to ensure that the plan was fair to obstetrical patients and to shield the plan from constitutional challenge. The Task Force explained in its report:
The Virginia statute does not require participating physicians and hospitals to give notice to obstetrical patients that they are participating in the limited no-fault alternative for birth-related neurological injuries. The Task Force recommends that health care providers who participate under this plan should be required to provide reasonable notice to patients of their participation. This notice requirement is justified on fairness grounds and arguably may be required in order to assure that the limited no fault alternative is constitutional.
Task Force Report at 34 (emphasis added). Since Florida's NICA plan was the result of the Task Force's report, it is only logical to conclude that the plan's notice requirement was included in the Florida legislation as a result of this recommendation and therefore was intended to be a condition precedent to immunity under the plan.
This Court's 1973 decision in Allen v. Estate of Carman, 281 So.2d 317 (Fla.1973), does not support a contrary conclusion. Contra Bradford v. Florida Birth-Related Neurological Injury Compensation Ass'n, 667 So.2d 401, 402 (Fla. 4th DCA 1995) (Klein, J., dissenting). In Allen, the Court addressed the section 440.05 notice requirement contained in the 1967 version of Florida's Worker's Compensation Act.
The employer in Allen, who had fewer than three employees, was not required to have worker's compensation coverage under the then existing law. Allen, 281 So.2d at 320 (citing § 440.02(1)(b)(2), Fla. Stat. (1967)). However, under the "Waiver of Exemption" provision, section 440.04, Florida Statutes (1967), the employer could waive the exemption by obtaining coverage. The employer obtained coverage but failed to post notice of the waiver of exemption in accor dance with section 440.05, Florida Statutes (1967).
After considering the 1967 "Waiver of Exemption" provision, the Court held that an employer's failure to post the required notice did not preclude the employer from asserting worker's compensation immunity. Allen, 281 So.2d at 322. Although under the 1967 version of the Act, participation in the worker's compensation plan was voluntary for the employer in Allen, the decision was not based on that fact. Rather, it was based on the plain language of section 440.04(3), Florida Statutes (1967), which expressly provided that effective waiver of exemption from chapter 440 is not dependant upon the posting of notice as provided in section 440.05. Allen 281 So.2d at 322. Section 440.04(3), which is currently found at section 440.04(2), Florida Statutes (1995), provides:
When any policy or contract of insurance specifically secures the benefits of this chapter to any person not included in the definition of "employee" or whose services are not included in the definition of "employment" or who is otherwise excluded or exempted from the operation of this chapter, the acceptance of such policy or contract of insurance by the insured and the writing of same by the carrier shall constitute a waiver of such exclusion or exemption and an acceptance of the provisions of this chapter with respect to such person, notwithstanding the provisions of s. U0.05 with respect to notice.
(Emphasis added.) The lack of a similar express statement in the NICA plan further supports our conclusion that notice under the plan was intended to serve as a condition precedent to immunity.
Moreover, our reading of NICA's notice provision will not frustrate the plan's goal of stabilizing the perceived medical malpractice insurance crisis affecting obstetricians by reducing their malpractice insurance premiums. Florida Birth-Related Neurological Injury Compensation Ass'n v. McKaughan, 668 So.2d 974 (Fla.1996); § 766.301(1), Fla. Stat. (1993). Under our reading of the statute, in order to preserve their immune status, NICA participants who are in a position to notify their patients of their participation a reasonable time before delivery simply need to give the notice in a timely manner. In those eases where it is not practicable to notify the patient prior to delivery, pre-deliv-ery notice will not be required.
Whether a health care provider was in a position to give a patient pre-delivery notice of participation and whether notice was given a reasonable time before delivery will depend on the circumstances of each ease and therefore must be determined on a case-by-case basis. Because the assertion of NICA exclusivity is an affirmative defense, factual disputes concerning notice should be submitted to the jury where a jury trial is requested on all questions of fact. Cf. McKaughan, 668 So.2d 974 (Fla.1996) (assertion of NICA's exclusivity of remedy is an affirmative defense); Central Fla. Regional Hosp., Inc. v. Wager, 656 So.2d 491, 492 (Fla. 5th DCA 1995) (where plaintiff requested that a jury resolve all questions of fact, issue of whether injury was covered by NICA plan was question of fact to be resolved by the jury), approved, 672 So.2d 34 (Fla.1996).
Accordingly, we answer the certified question as explained herein and approve the decision under review.
It is so ordered.
SHAW, HARDING, WELLS and ANSTEAD, JJ., concur.
OVERTON, J., dissents with an opinion, in which GRIMES, J., concurs.
. The Task Force obviously believed that because not all health care providers are required to participate in the NICA plan, fairness requires that the patient be made aware that she has limited her common law remedies by choosing a participating provider.
. The Task Force also must have recognized that failure to require notice would open the plan up to constitutional attack. For example, the Bran-iffs argue that if pre-delivery notice is not a condition precedent to immunity under the plan, patients will be deprived of their common law remedies without due process. However, because of our resolution of the notice issue, we need not reach the merit of this procedural due process challenge.
.The notice requirement at issue in Allen provided in pertinent part:
Every employer who . waives such exemption . shall post and keep posted in a conspicuous place or places in and about his place or places of business typewritten or printed notices to such effect in accordance with a form to be prescribed by the commission. He shall file a duplicate of such notice with the commission.
Allen, 281 So.2d at 322 (quoting § 440.05, Fla. Stat. (1967)).
. The current version of the "Waiver of Exemption" provision is identical to the version at issue in Allen.