Case Name: Cleo Allen BUTLER, Individually and for and on Behalf of the Minor, Michelle Butler and Arlene Major as Custodian of the Minor, Michelle Butler, v. FLINT GOODRICH HOSPITAL OF DILLARD UNIVERSITY, Jerome T. Medley, Warren P. McKenna, Jr., M.D., Sandra Viglia, Joseph Braud, M.D. and Sherman Bernard in his Capacity as Commissioner of Insurance, et al.
Court: Louisiana Supreme Court
Jurisdiction: Louisiana
Decision Date: 1992-10-19
Citations: 607 So. 2d 517
Docket Number: No. 92 CC 0559
Parties: Cleo Allen BUTLER, Individually and for and on Behalf of the Minor, Michelle Butler and Arlene Major as Custodian of the Minor, Michelle Butler, v. FLINT GOODRICH HOSPITAL OF DILLARD UNIVERSITY, Jerome T. Medley, Warren P. McKenna, Jr., M.D., Sandra Viglia, Joseph Braud, M.D. and Sherman Bernard in his Capacity as Commissioner of Insurance, et al.
Judges: CALOGERO, C.J., and LEMMON, J., dissent and assign reasons.
Reporter: Southern Reporter, Second Series
Volume: 607
Pages: 517–532

Head Matter:
Cleo Allen BUTLER, Individually and for and on Behalf of the Minor, Michelle Butler and Arlene Major as Custodian of the Minor, Michelle Butler, v. FLINT GOODRICH HOSPITAL OF DILLARD UNIVERSITY, Jerome T. Medley, Warren P. McKenna, Jr., M.D., Sandra Viglia, Joseph Braud, M.D. and Sherman Bernard in his Capacity as Commissioner of Insurance, et al.
No. 92 CC 0559.
Supreme Court of Louisiana.
Oct. 19, 1992.
Dissenting Opinion by Justice Dennis, Nov. 10, 1992.
Rehearing Denied Nov. 25, 1992.
Darleen M. Jacobs, Brian C. Beckwith, James L. Yates, New Orleans, for applicants.
Franklin D. Beahm, Katherine B. Mus-low, Thomas, Hayes & Beahm, Lawrence L. McNamara, Philip O. Bergeron, Robert J. Conrad, Jr., Adams & Reese, New Orleans, C.T. Williams, Jr., J. Elliott Baker, Blue, Williams & Buckley, Metairie, for respondents.
Joseph W. Thomas, New Orleans, for Norward Sutton, Sr., amicus curiae.
Robert G. Pugh, Jr., Lamar P. Pugh, Pugh, Pugh & Pugh, Shreveport, for Louisiana Medical Mut. Ins. Co., amicus curiae.
Lawrence S. Kullman, New Orleans, David W. Robertson, Baton Rouge, for Louisiana Trial Lawyers Ass’n, amicus curiae.
George E. Cain, Bryan Misshore, Kelley A. Robichaux, Lemle & Kelleher, New Orleans, for Ins. Corp. of America, amicus curiae.
Richard P. Ieyoub, Atty. Gen., Athena B. Peidrahita, Asst. Atty. Gen., for State, ami-cus curiae.
Charles A. Boggs, Boggs, Loehn & Ro-drigue, New Orleans, for Dr. Susan Jean-freau, amicus curiae.
Robert L. Roland, Peter T. Dazzio, P. Scott Jolly, Baton Rouge, for Louisiana Hosp. Ass’n and Louisiana Hosp. Ass’n Ins. Trust Fund, amicus curiae.
H. Evans Scobee, Durrett, Hardin, Hunter, Dameron & Fritchie, Baton Rouge, for East Baton Rouge Parish Medical Soc., amicus curiae.
Larry M. Roedel, Roedel Parsons Forres-ter & Koch, Baton Rouge, for Louisiana Dental Ass’n, amicus curiae.
Marc W. Judice, Juneau, Judice, Hill & Adley, Lafayette, for The Ninth Dist. of Louisiana State Medical Soc., amicus curiae.
Cynthia C. Anderson, Gregg A. Wilkes, Cook, Yancey, King & Galloway, Shreveport, for Shreveport Medical Soc., The North Cent. Parishes Medical Soc., The Delta Medical Soc., and the Morehouse Parish Medical Soc., amicus curiae.
Jesse D. McDonald, Hudson, Potts & Bernstein, Monroe, for Louisiana State Medical Soc. and Ouachita Parish Medical Soc., amicus curiae.
Donna D. Fraiche, Michael M. Meunier, Elaine W. Selle, Locke Purnell Rain Harrell, New Orleans, for Orleans Parish Medical Soc. and The Jefferson Parish Medical Soc., amicus curiae.

Opinion:
WATSON, Justice.
The issue presented is the constitutionality of Louisiana's $500,000 cap on general damages in a medical malpractice victim's suit against multiple defendants. LSA-R.S. 40:1299.42(B)(1).
FACTS
In May of 1976, a three year old child, Michelle Butler, had complications following eye surgery. After suffering cardiac arrest, she was rendered blind, paralyzed and retarded. Michelle's maternal grandmother, Arlene Major, was appointed tu-trix. She and the minor's attorney released the Flint-Goodrich Hospital, a division of Dillard University, and its employee, Sandra Yiglia Williams, a nurse-anesthetist, for $100,000. The minor's rights against other parties, including the Louisiana Patient's Compensation Fund, Dr. Jerome Medley, Dr. Warren McKenna, and Dr. Joseph Braud, were reserved. It is alleged that there is excess coverage on some or all of the other health care providers, but plaintiff's discovery was prohibited.
The trial court gave judgment against the Louisiana Patient's Compensation Fund for $400,000 and ordered the Fund to pay Michelle Butler's medical care and related expenses from April 27, 1990. Plaintiff was awarded $244,275 for past care. After tender of its $400,000 was refused, the Fund deposited that sum in the court registry.
Drs. Medley, McKenna and Braud filed a motion for summary judgment because Michelle had received the maximum $500,000 recovery allowed by LSA-R.S. 40:1299.-42(B)(1). The trial court denied the motion. The court of appeal granted a writ and ordered that summary judgment be entered. This court granted a writ to review the ruling of the court of appeal.
LAW
The Louisiana Constitution mandates equal protection • of the laws. Art. I, § 3. It prohibits arbitrary, capricious or unreasonable discrimination because of physical condition. Art. I, § 3 and 12. Open courts must provide an adequate remedy, administered without partiality, for injury to persons and property. Art. I, § 22.
Imperfections in legislation are not grounds for judicial intervention unless they result in denial of constitutional rights. James v. Strange, 407 U.S. 128, 92 S.Ct. 2027, 32 L.Ed.2d 600 (1972); Everett v. Goldman, 359 So.2d 1256 (La.1978). Consistent with most other state supreme courts, Everett held that medical malpractice legislation does not infringe upon fundamental rights. See, for example, Condemarin v. University Hosp., 775 P.2d 348 (Utah 1989). Also see Tull v. United States, 481 U.S. 412, 107 S.Ct. 1831, 95 L.Ed.2d 365 (1987) and Boyd v. Bulala, 877 F.2d 1191 (4th Cir.1989). Two provisions of the Louisiana Act were approved in Ever ett: medical review panels and no demand for a dollar amount. Compare Hoem v. State, 756 P.2d 780 (Wyo.1988), which held that medical review panels deny equal protection.
Sibley I, Sibley v. Board of Sup'rs of Louisiana, 462 So.2d 149 (La.1985), held that limiting medical malpractice awards to $500,000 per patient does not violate the equal protection and due process guarantees of the state and federal constitutions or the state constitutional guarantee of access to courts. A rehearing was granted and those issues were given further scrutiny in Sibley II, Sibley v. Board of Sup'rs of Louisiana, 477 So.2d 1094 (La.1985), which rejected the federal three-tier system of scrutiny. Sibley II decided that the physical condition discrimination in Louisiana's medical malpractice act, between those more and less severely injured, must further a legitimate state interest. Sibley II remanded, ordering that the state's interests be balanced against the discrimination to determine if the legislative classifications were arbitrary, capricious and unreasonable. The case was settled.
After a Sibley II analysis, the fourth circuit found the cap valid in Williams v. Kushner, 524 So.2d 191 (La.App. 4th Cir.1988). The evidence included testimony that some health care providers were "bare" of malpractice insurance before the passage of Act 817 of 1975. Williams v. Kushner, 549 So.2d 294 (La.1989), amended and affirmed the court of appeal opinion without a definitive holding on the constitutional issue. Williams confirmed the validity of the $400,000 cap on general damages from the Fund but pretermitted the question of limiting payment by an individual health care provider to $100,000.
Plaintiff's withdrawal of a doctor's $100,000 deposit in a court registry settled plaintiff's claim against the doctor. Ewing v. Aubert, 566 So.2d 616 (La.1990). Payment of $100,000 by one qualified health care provider triggers the Fund's liability for excess damages. Stuka v. Fleming, 561 So.2d 1371 (La.1990) cert. denied, 498 U.S. -, 111 S.Ct. 513, 112 L.Ed.2d 525 (1990). The Fund cannot contest liability when there is a settlement for $100,000 by a health care provider before or after trial. Koslowski v. Sanchez, 576 So.2d 470 (La.1991).
The fourth circuit again found the cap constitutional in LaMark v. NME Hospitals, Inc., 542 So.2d 753 (La.App. 4th Cir.1989) writ denied, 551 So.2d 1334 (La.1989). Despite the lack of an express decision from this court, the United States Fifth Circuit inferred that the cap meets Louisiana's constitutional requirements. Owen v. U.S., 935 F.2d 734 (5th Cir.1991) cert. denied, — U.S. -, 112 S.Ct. 870, 116 L.Ed.2d 775 (1992).
Under Louisiana's medical malpractice act, liability of multiple health care providers, to an aggregate exceeding $100,000, does not inure to the victim but reduces the excess due from the Fund. LSA-R.S. 40:1299.42(B)(3)(a). The total amount paid from multiple health care providers shall not exceed $500,000. LSA-R.S. 40:1299(B)(1) and (3)(b).
Since the Louisiana Act does not affect fundamental rights, the constitutional test is whether its provisions are reasonably related to furthering general social interests. Sibley II; Bazley v. Tortorich, 397 So.2d 475 (La.1981).
Other state courts of last resort have addressed these constitutional issues.
Lucas v. United States, 757 S.W.2d 687 (Tex.1988), answering a certified question from the United States Fifth Circuit, concluded that a $500,000 limitation on medical malpractice damages unconstitutionally limited open access to the Texas courts. The legislation failed to provide an adequate substitute, a societal quid pro quo. Moreover, reducing recovery of persons catastrophically injured by medical negligence was arbitrary, because it had no rational relationship to the state's interests.
Smith v. Department of Insurance, 507 So.2d 1080 (Fla.1987), invalidated a $450,-000 ceiling on noneconomic damages as an arbitrary cap denying constitutional access to the courts and the right to a jury trial.
Rose v. Doctors Hasp., 801 S.W.2d 841 (Tex.1990), decided that the $500,000 Texas cap on damages for wrongful death, a statutory remedy, was valid. The wrongful death cap was distinguished and severed from the common law remedy for malpractice. However, the statutory cap on wrongful death damages was interpreted to allow excess damages to a plaintiff recovering against more than one defendant.
Alabama's $400,000 limit on noneconomic damages recoverable against physicians violates the constitutional guarantee of equal protection. Moore v. Mobile Infirmary Ass'n, 592 So.2d 156 (Ala.1991). Balancing the direct burden on catastrophically injured victims of medical malpractice against the indirect and speculative benefit to society, Moore found that any reduction of general health care costs was attenuated and remote, while the burden on those most severely injured by medical malpractice was immense. Also, the limitation on damages for noneconomic losses was an impermissible burden on the inviolate right to trial by jury guaranteed by the Alabama Constitution.
Moore criticizes a contrary opinion in Etheridge v. Medical Center Hosp., 237 Va. 87, 376 S.E.2d 525 (1989). Etheridge was also distinguished, because the Virginia Constitution (like Louisiana's) does not guarantee an inviolate right to a civil jury trial.
Many of the cases from other jurisdictions invalidate damage caps because of a state constitutional right to jury trial in civil cases. For example, Washington, Pennsylvania, Illinois, Ohio, Delaware and Florida have constitutional provisions which guarantee the right to civil jury trial, a provision lacking in the Louisiana constitution. See Sofie v. Fibreboard Corp., 112 Wash.2d 636, 771 P.2d 711 (1989); Mattos v. Thompson, 491 Pa. 385, 421 A.2d 190 (1980); Wright v. Central Du Page Hosp. Ass'n, 63 Ill.2d 313, 347 N.E.2d 736 (1976); Duren v. Suburban Comm'ty Hosp., 24 Ohio Misc.2d 25, 24 OBR 450, 495 N.E.2d 51 (1985); Lacy v. Green, 428 A.2d 1171 (Del.Super.1981); and Smith, supra. Compare the discussion of the Seventh Amendment's scope in Davis v. Omitowoju, 883 F.2d 1155 (3d Cir.1989).
The New Hampshire Supreme Court invalidated an $875,000 cap on noneconomic personal injury loss as a violation of state equal protection. Brannigan v. Usitalo, 134 N.H. 50, 587 A.2d 1232 (1991). The court had earlier nullified a $250,000 cap on noneconomic damages for medical malpractice. Carson v. Maurer, 120 N.H. 925, 424 A.2d 825 (1980).
Morris v. Savoy, 61 Ohio St.3d 684, 576 N.E.2d 765 (1991), held that a $200,000 cap on general damages for medical malpractice was unconstitutional on due process grounds. There was no evidence of a rational connection between excess awards and malpractice insurance rates and therefore no real and substantial relationship to public welfare. In addition, the statute was found to be unreasonable and arbitrary by imposing the cost of any benefit to the public upon a class consisting of those most severely injured by medical malpractice.
In answer to a certified question, the Supreme Court of Kansas decided that a $250,000 statutory cap on noneconomic tort damages did not violate the right to jury trial or due process, because there was a legislative quid pro quo. Samsel v. Wheeler Transport Services, 246 Kan. 336, 789 P.2d 541 (1990) (overruled on other grounds in Bair, infra). Kansas constitutionally eliminated vicarious liability for medical malpractice by providing an adequate substitute remedy, an assured fund of $3,200,-000 for payment of damages. Bair v. Peck, 248 Kan. 824, 811 P.2d 1176 (1991).
West Virginia upheld a one million dollar medical malpractice cap on noneconomic loss. Robinson v. Charleston Area Med. Center, Inc., 186 W.Va. 720, 414 S.E.2d 877 (1991). Robinson applied its cap to the aggregated claims of a child and his parents, thereby eliminating recovery by the parents, secondary claimants. This interpretation accords with the language of the Louisiana statute, which applies the cap per patient.
Maryland caps noneconomic personal injury damages at $350,000. Murphy v. Edmonds, 325 Md. 342, 601 A.2d 102 (1992).
Indiana's $500,000 medical malpractice cap on damages was declared constitutional in Johnson v. St. Vincent Hospital, Inc., 273 Ind. 374, 404 N.E.2d 585 (1980). Also see Cha v. Warnick, 476 N.E.2d 109 (Ind.1985) cert. denied, 474 U.S. 920, 106 S.Ct. 249, 88 L.Ed.2d 257 (1985). Both Indiana and Louisiana have provided the alternative remedy of a patient's compensation fund. However, unlike Louisiana, Indiana has made no provision for payment of full medical care and related benefits to medical malpractice victims. See LSA-R.S. 40:1299.43(A)(1) and (3). Arneson v. Olson, 270 N.W.2d 125 (N.D.1978) noted that North Dakota's $300,000 cap might prevent some malpractice victims from recovering all their medical expenses.
In many states, the problem of uninsured physicians, unable or unwilling to buy insurance, resulted in statutes mandating coverage. See, for example, the statutes declared constitutional in McCoy v. Com., Bd. of Medical Ed. & Licensure, 37 Pa. Commw. 530, 391 A.2d 723 (1978); Kansas ex rel Schneider v. Liggett, 223 Kan. 610, 576 P.2d 221 (1978); and Jones v. State Board of Medicine, 97 Idaho 859, 555 P.2d 399 (1976) cert. denied, 431 U.S. 914, 97 S.Ct. 2173, 53 L.Ed.2d 223 (1977). Compare McGuffey v. Hall, 557 S.W.2d 401 (Ky.1977), which found a denial of equal protection. Participation in Louisiana's medical malpractice insurance plan is voluntary, but the plan does make insurance available to "qualified risks" unable to obtain private insurance. LSA-R.S. 40:1299.-46. Compare the mandatory physician funding for birth-related neurological injuries established in Virginia. King v. Neurological Injury Comp. Program, 242 Va. 404, 410 S.E.2d 656 (1991).
CONCLUSION
This court decided two threshold issues in Williams v. Kushner, 549 So.2d 294 (La.1989). The liability of the settling health care provider is moot, and limitation of the Fund's liability to $400,000 is constitutional. We now hold that the $500,000 cap on medical malpractice judgments is also constitutional.
Although a subject of debate, the existence of a medical malpractice insurance crisis was widely acknowledged when Louisiana's Medical Malpractice Act of 1975 was passed. See 50 Tulane Law Review 655 (1976) and Medical Malpractice by Louisell and Williams, vol. 2, § 20.07 (1990). It is undisputed that the severable provisions of the Louisiana Act were a legislative response to the perceived "crisis". Everett. The Medical Malpractice Act does not affect fundamental rights. Everett.
The statutory cap on medical malpractice judgments in excess of $500,000 distinguishes between classes of persons according to their physical condition. One group, those with injuries evaluated below $500,-000, are fully compensated. The other group of malpractice victims, those with damages above $500,000, are fully compensated only for their medical expenses and related benefits. The question is whether that discrimination is arbitrary, capricious and unreasonable. Sibley II.
As an offset to the Act's $500,000 limitation, Louisiana now offers those most severely injured by medical malpractice three benefits: (1) greater likelihood that the offending physician or other health care provider has malpractice insurance; (2) greater assurance of collection from a solvent fund; and (3) payment of all medical care and related benefits. Compensation and full medical care for those grossly injured by medical malpractice are legitimate social interests, which are furthered by the malpractice legislation. The discrimination in the Act against those with excessive injuries is accompanied by a quid pro quo: a reasonable alternative remedy has been provided. See Bazley. Since the legislature's statutory solution to the medical malpractice problem furthers the state purpose of compensating victims, it is not constitutionally infirm.
Overall, the Louisiana Medical Malpractice Act represents a reasonable but imperfect balance between the rights of victims and those of health care providers. It does not violate the state or federal constitutions.
For the foregoing reasons, the judgment of the court of appeal is affirmed.
AFFIRMED.
CALOGERO, C.J., and LEMMON, J., dissent and assign reasons.
DENNIS, J., dissents with reasons.