Case Name: Prince A. WILLIAMS v. Jack KUSHNER, et al.
Court: Louisiana Supreme Court
Jurisdiction: Louisiana
Decision Date: 1989-09-12
Citations: 549 So. 2d 294
Docket Number: Nos. 88-C-1153, 88-C-1188
Parties: Prince A. WILLIAMS v. Jack KUSHNER, et al.
Judges: LEMMON, J., concurs and assigns additional reasons.
Reporter: Southern Reporter, Second Series
Volume: 549
Pages: 294–315

Head Matter:
Prince A. WILLIAMS v. Jack KUSHNER, et al.
Nos. 88-C-1153, 88-C-1188.
Supreme Court of Louisiana.
Sept. 12, 1989.
Concurring Opinion by Justice Calogero Sept. 22, 1989.
Rehearing Denied Oct. 19, 1989.
Joseph Thomas, Angelique Reed, Ammon Miller, Jr., New Orleans, for Prince A. Williams.
Stephen Sullivan, New Orleans, Rene Pastorek, Gretna, for La. Patient’s Compensation Fund and Sherman Bernard.
Sam LeBlanc, III, Robert Conrad, Jr., Richard Goins, Adams & Reese, New Orleans, for Louisiana State Medical Soc. and Louisiana Medical Mut. Ins. Co.
Carter G. Phillips, David Orentlicher, Sid-ley & Austin, Sam A. LeBlanc, III, Robert J. Conrad, Jr., Richard A. Goins, Adams & Reese, New Orleans, Kirk B. Johnson, Martin J. Hatlie, amicus curiae, for the American Medical Ass’n.
David W. Robertson, Baton Rouge, ami-cus curiae, for The Ass’n of Trial Lawyers of America and The Louisiana Trial Lawyers Ass’n.
S. Sanford Levy, New Orleans, amicus curiae, for S. Sanford Levy.
Robert L. Roland, Felix R. Weill, Katherine Long Gilmore, Baton Rouge, amicus curiae, for The Louisiana Hosp. Ass’n and Louisiana Hosp. Ass’n Ins. Trust.
Herbert J. Mang, Jr., Glen Scott Love, Mathews, Atkinson, Guglielmo, Marks & Day, Baton Rouge, amicus curiae, for the Louisiana Dental Ass’n.
Allan Berger, Berger & Forstall, James A. Wysocki, Stephanie Hraehovy, New Orleans, Attys. filing amicus curiae.

Opinion:
PER CURIAM.
A writ was granted principally to consider the constitutionality of the $500,000 "cap" on recovery for a person injured by medical malpractice. On closer analysis following briefing and argument, it has become apparent that the recovery limitation is not presented in the context originally thought. A more careful study has revealed that there are three issues in these proceedings, one of which is moot.
The three issues are as follows:
(1) The constitutionality of the $400,000 limitation on recovery from the Patient's Compensation Fund.
(2) The constitutionality of the $100,000 limitation on recovery against a qualified health care provider.
(3) The constitutionality of denying the costs of future medical care and related benefits to a patient injured in a private facility and filing a claim prior to September 1, 1984.
This opinion decides the first and third issues, but for reasons discussed below, the second issue is not before the court.
Suit was filed in January, 1983 by Prince A. Williams to recover damages for permanent injuries sustained by his son, Mark Williams, at his birth in a private hospital. The attending doctor, Dr. Jack Kushner, settled with plaintiff prior to trial for $100,-000. Plaintiff was given a jury trial on quantum, and there was an unitemized verdict for $1,829,000.
After a Sibley hearing, the trial court reduced the damages to the statutory limit of $400,000 and entered judgment for plaintiff against the Patient's Compensation Fund for $400,000 plus legal interest and costs. The court of appeal affirmed the judgment of the trial court. Writs were granted to review the decision.
The record supports the jury's award of damages in excess of $500,000. Mark Williams has a useless right arm. He was diagnosed as having Erb's palsy and Klumke's palsy. It was stipulated that the injury occurred at birth and that the damage is permanent. Because of balance problems, Mark's physical activity is restricted: he has a poor self image and little self confidence. At every stage of his development, and particularly during adolescence, he will suffer from his handicap. He will never be able to engage in any activity requiring two hands or two arms. Discounted to present value, his future loss of earnings was estimated at $193,736. There was testimony that both Mark and his parents will need extensive psychological counseling to enable them to cope with his handicap.
The Louisiana statutory scheme places a $100,000 maximum on the health care provider's liability and provides a $400,000 supplemental amount available to each injured person, payable from the state operated Patient's Compensation Fund, thus limiting recovery to a total of $500,000. Plaintiff's suit attacks the total, claiming that the PCF should be cast for the entire amount (less $100,000) awarded by the jury.
I. Recovery Against the Patient's Compensation Fund.
For damages other than future medical care and related benefits, the $400,000 limitation on recovery from the Patient's Compensation Fund is a valid restriction. As the Supreme Court of Kansas observed:
"Because the Fund is a state-run insurance company, the State is free to limit its liability in any amount it wishes. The issue presented here is one of limiting the liability of a tortfeasor, namely the negligent health care provider." Kansas Malpractice Victims v. Bell, 243 Kan. 333, 757 P.2d 251, 256 (1988) (emphasis added).
The legislature had the power to establish the fund and provide a supplemental recovery for those more seriously injured by medical malpractice. This affirmative act is not subject to the Sibley constitutional analysis. The fund is not a negligent party and does not have the status of an Article 2315 defendant.
Thus, there is no constitutional infirmity in the state's providing for payment of $400,000 in damages to plaintiff on behalf of his minor son, and plaintiff has no constitutional claim for a greater amount. See Prendergast v. Nelson, 199 Neb. 97, 256 N.W.2d 657 (1977).
II. Recovery Against the Health Care Provider.
In view of the conclusion reached on the first issue, it is apparent that the fundamental question involved is: what about the statutory limit of $100,000 damages payable by the doctor? This is indeed a vexing and difficult issue, as witness the disparate results reached in other states. To illustrate, Fein v. Permanente Medical Group, 38 Cal.3d 137, 211 Cal.Rptr. 368, 695 P.2d 665 (1985), upheld a $250,000 California limit on noneconomic damages; while Smith v. Department of Ins., 507 So.2d 1080 (Fla.1987) declared a Florida statute placing a $450,000 cap on noneco-nomic losses unconstitutional. For a more or less complete summary of treatment by the various states, see Appendix II.
Rephrased the issue here would be: Can the State of Louisiana limit a health care provider's liability to a maximum of $100,-000 in a general scheme governing recovery for medical malpractice, which includes a limitation on total recovery of $500,000, without violating the equal protection and adequate remedy clauses of the Louisiana Constitution?
The answer must await another day; the issue is not before the court. Dr. Jack Kushner, the treating physician, was released from the suit prior to trial. Because of the settlement with Dr. Kushner, the health care provider, his liability is a moot question.
III. Future Medical Care and Related Benefits.
While the third issue was not assigned as error in the precise language used here, the issue is implicit in the arguments urged by relator. Treatment of the question of medical benefits is appropriate at this time.
In 1984, Act 435 enacted LSA-R.S. 40:1299.43 to provide that the cost of "future medical care and related benefits" is excluded from the $500,000 limitation on recovery in private sector claims. In 1985, the same exception was made with regard to malpractice claims against the state. However, the 1984 private sector act applies only to malpractice claims filed "on or after September 1, 1984," and would exclude the present claim. The 1985 act applies to "pending claims and litigation." Thus, if Mark Williams had been injured at birth in a state facility under the care of a state employee, his future medical expenses could be recovered. Because he was born in a private hospital under the care of a private physician, these expenses are legislatively placed in a different category. This anomaly is a clear violation of the Louisiana constitutional guarantee of equal protection.
Despite wording to the contrary, Act 435 of 1984 must be reformed to apply to claims and litigation pending when it was passed. Plaintiff here is entitled to a judgment for the benefits provided.
For the foregoing reasons, the judgment of the court of appeal is amended to award plaintiff any future medical expenses and related benefits according to LSA-R.S. 40:1299.43. The judgment of the court of appeal, which upheld a $400,000 award against the Patient's Compensation Fund, is affirmed as amended.
AMENDED AND AFFIRMED.
LEMMON, J., concurs and assigns additional reasons.
COLE, J., additionally concurs to join in the reasons assigned by LEMMON, J.
CALOGERO, J., additionally concurs and assigns reasons.
MARCUS, J., concurs in part and dissents in part and assigns reasons.
DIXON, C.J., and DENNIS, J., dissent with reasons.
APPENDIX I
LSA-R.S. 40:1299.43 provides:
A. (1) In all malpractice claims filed with the commissioner of insurance which proceed to trial, the jury shall be given a special interrogatory asking if the patient is in need of future medical care and related benefits and the amount thereof.
(2) In actions upon malpractice claims tried by the court, the court's finding shall include a recitation that the patient is or is not in need of future medical care and related benefits and the amount thereof.
(3) If the total amount is for the maximum amount recoverable, exclusive of the value of future medical care and related benefits, the cost of all future medical care and related benefits shall be paid in accordance with this Section.
(4) If the total amount is for the maximum amount recoverable, including the value of the future medical care and related benefits, the amount of future medical care and related benefits shall be deducted from the total amount and shall be paid from the patient's compensation fund as incurred and presented for payment. The remaining portion of the judgment shall be paid in accordance with R.S. 40:1299.44(A)(7) and 40:1299.-44(B)(1), (B)(2) and (B)(3).
(5) In all cases where judgment is rendered for a total amount less than the maximum amount recoverable, including any amount awarded on future medical care and related benefits, payment shall be in accordance with R.S. 40:1299.-44(A)(7) and 40:1299.44(B)(1), (B)(2), and (B)(3).
(6) The provisions of this Subsection shall be applicable to all malpractice claims filed on or after September 1, 1984.
(B)(1) "Future medical care and related benefits" for the purpose of this Section means all reasonable medical, surgical, hospitalization, physical rehabilitation, and custodial services and includes drugs, prosthetic devices, and other similar materials reasonably necessary in the provision of such services.
(2) "Future medical care and benefits" as used in this Section shall not be construed to mean non-essential specialty item or devices of convenience.
C. Once a judgment is entered in favor of a patient who is found to be in need of future medical care and related benefits or a settlement is reached between a patient and the patient's compensation fund in which the provision of medical care and related benefits is agreed upon and continuing as long as medical or surgical attention is reasonably necessary, the patient may make a claim to the patient's compensation fund through the office of the attorney general for all future medical care and related benefits directly or indirectly made necessary by the health care provider's malpractice unless the patient refuses to allow them to be furnished.
D. Payments for medical care and related benefits shall be paid by the patient's compensation fund without regard to the five hundred thousand dollar limitation imposed in R.S. 40:1299.42.
E. (1) The district court from which final judgment issues shall 'have continuing jurisdiction in cases where medical care and related benefits are determined to be needed by the patient.
(2) The court shall award reasonable attorney fees to the claimant's attorney if the court finds that the patient's compensation fund unreasonably fails to pay for medical care within thirty days after submission of a claim for payment of such benefits.
(F). Nothing in this Section shall be construed to prevent a patient and a health care provider and/or the patient's compensation fund from entering into a court-approved settlement agreement whereby medical care and related benefits shall be provided for a limited period of time only or to a limited degree.
(G). The patient's compensation fund shall be entitled to have a physical examination of the patient by a physician of the patient's compensation fund's choice from time to time for the purpose of determining the patient's continued need of future medical care and related benefits, subject to the following requirements:
(1)(a) Notice in writing shall be delivered to or served upon the patient or the patient's counsel of record, specifying the time and place where it is intended to conduct the examination.
(b) Such notice must be given at least ten days prior to the time stated in the notice.
(c) Delivery of the notice may be by certified mail.
(2) Such examination shall be by a licensed medical physician or chiropractic physician licensed under the laws of this state or of the state, parish, or county wherein the patient resides.
(3)(a) The place at which such examination is to be conducted shall not involve an unreasonable amount of travel for the patient considering all circumstances.
(b) It shall not be necessary for a patient who resides outside this state to come into this state for such an examination unless so ordered by the court.
(4) Within thirty days after the examination, the patient shall be compensated by the party requesting the examination for all necessary and reasonable expenses incidental to submitting to the examination including the reasonable costs of travel, meals, lodging, loss of pay, or other direct expenses.
(5)(a) Examinations may not be required more frequently than at six months intervals except that, upon application to the court having jurisdiction of the claim and after reasonable cause shown therefor, examination within a shorter interval may be ordered.
(b) In considering such application, the court should exercise care to prevent harassment to the patient.
(6)(a) The patient shall be entitled to have a physician or an attorney of his own choice or both present at such examination.
(b) The patient shall pay such physician or attorney himself.
(7) The patient shall be promptly furnished with a copy of the report of the examination made by the physician making the examination on behalf of the patient's compensation fund.
(H). If a patient fails or refuses to submit to examination in accordance with a notice and if the requirements of Subsection G of this Section have been satisfied, then the patient shall not be entitled to attorney fees in any action to enforce rights pursuant to Subsection E of this Section.
(I). (1) Any physician selected by the patient's compensation fund and paid by the patient's compensation fund who shall make or be present at an examination of the patient conducted in pursuance of this Section may be required to testify as to the conduct thereof and the findings made.
(2) Communications made by the patient upon such examination by such physician or physicians shall not be considered privileged.
(J). The patient's compensation fund shall pay all reasonable fees and costs of medical examinations and the costs and the fees of the medical expert witnesses in any proceeding in which the termination of medical care and related benefits is sought.
APPENDIX II
State Court Cases Considering the Constitutionality of Medical Malpractice Damage Limitations
I. Four states have upheld medical malpractice limitations on damages: Indiana; California; Nebraska and Virginia. California only limits noneconomic damages for medical malpractice and Virginia has a "cap" of $750,000.
Johnson v. St. Vincent Hospital, Inc., 273 Ind. 374, 404 N.E.2d 585 (1980) upheld the Indiana medical malpractice act. The Louisiana Act is modeled on the Indiana Act, which provides a $500,000 limit on total recovery and a $100,000 limit on the liability of a health care provider for one occurrence. A state fund gives coverage between $100,000 and $500,000. The patient's compensation fund is administered by the Indiana Insurance Commissioner. Although the Louisiana act was amended to remove the limitation on medical expenses, the Indiana act has not been changed.
Fein v. Permanente Medical Group, 38 Cal.3d 137, 211 Cal.Rptr. 368, 695 P.2d 665 (1985) upheld a California statute which limited recovery of noneconomic damages to $250,000, but did not limit recovery of economic losses. Footnote 17 of Fein points out that the American Bar Association's Commission on Medical Professional Liability has recommended that no dollar limit be imposed on recovery of economic losses. Fein also upheld a provision of the California statute which gives credit for any collateral recovery by a plaintiff against the total damages, thereby modifying the collateral source rule.
Prendergast v. Nelson, 199 Neb. 97, 256 N.W.2d 657 (1977), considered the constitutionality of the Nebraska act which places a $500,000 ceiling on recovery for medical malpractice. Prendergast concluded that a claimant was being assured of $500,000 for the payment of any malpractice claim and thereby given a remedy not previously available.
Etheridge v. Medical Center Hospitals, 237 Va. 87, 376 S.E.2d 525 (1989), upheld the Virginia statute which limited the total amount recoverable by one party against a health care provider to $750,000. The current statute raises the limit to $1 million. Other questions arising under the Virginia statute were certified to the Virginia Supreme Court in Boyd v. Bulala, 877 F.2d 1191 (4th Cir.1989).
II. Six states have decided that a medical malpractice "cap" is unconstitutional: Idaho; Illinois; Kansas; New Hampshire; North Dakota and Texas.
Jones v. State Board of Medicine, 97 Idaho 859, 555 P.2d 399 (1976) involved the Idaho medical malpractice act which had physician and hospital limits of $150,000 per claim and $300,000 per occurrence. The case was remanded for factual findings on the equal protection issue under an intermediate standard of review, i.e., whether the legislative means substantially furthered a valid state purpose. After remand, the act was declared unconstitutional.
Wright v. Central Du Page Hospital Association, 63 Ill.2d 313, 347 N.E.2d 736 (1976), decided that an act limiting medical malpractice recovery to $500,000 was an arbitrary, special law, which also violated the Illinois constitution by vesting judicial power in medical review panels and restricting the right to trial by jury.
In Kansas, the total recovery for medical malpractice was capped at $1,000,000 with noneconomic loss limited to $250,000. A state fund provided coverage for uninsura-ble risks and claims exceeding $200,000. The Kansas scheme allowed supplemental payments by the fund for future medical care and related benefits up to a limit of $3,000,000 per claim through court proceedings. In Kansas Malpractice Victims v. Bell, 243 Kan. 333, 757 P.2d 251 (1988) the court stated that the fund constituted a state insurance company and the state could limit its liability, the issue being the constitutionality of limiting the net liability of the tortfeasors, the negligent health care providers. The Kansas Supreme Court concluded that the malpractice legislation was unconstitutional in failing to provide medical malpractice victims a full remedy by due course of law as guaranteed by the Kansas constitution. In addition, the legislation violated the Kansas bill of rights' guarantee of trial by jury.
The Supreme Court of New Hampshire stated:
It is simply unfair and unreasonable to impose the burden of supporting the medical care industry solely upon those persons who are most severely injured and therefore most in need of compensation. Carson v. Maurer, 120 N.H. 925, 424 A.2d 825, 837 (1980).
New Hampshire had a $250,000 cap on noneconomic damages which was found to violate that state's guarantee of equal protection.
In Arneson v. Olson, 270 N.W.2d 125 (N.D.1978), the North Dakota Supreme Court held that a $300,000 limitation on recovery for medical malpractice was a violation of the equal protection provision of the North Dakota constitution and the Fourteenth Amendment to the United States Constitution. The North Dakota scheme provided $100,000 in insurance for health care providers and participation in a fund for excess coverage up to $300,000. The North Dakota court noted that no state court of last resort had upheld a limitation as low as $300,000.
In Lucas v. U.S., 757 S.W.2d 687 (Tex. 1988), answering a certified question, the Texas Supreme Court decided that a $500,-000 limit on medical malpractice damages against a physician or health care provider violated the Texas constitution's guarantee of "open courts." The Texas limitation applied separately to each physician or health care provider and the limitation did not apply to past or future medical, hospital and custodial care.
III. At least two states have struck down limitations on all noneconomic damages: Florida and Washington.
In Smith v. Department of Ins., 507 So.2d 1080 (Fla.1987), the Florida Supreme Court invalidated a $450,000 ceiling on all noneconomic damages.
Sofie v. Fibreboard Corp., 112 Wash.2d 636, 771 P.2d 711 (1989) considered a statute limiting noneconomic damages according to a formula applied to jury verdicts. The formula was found to violate Washington's constitutional guarantee of trial by jury.
IV. Other state courts of last resort have: (1) upheld a three-year statute of limitation on suits for medical malpractice, Reynolds v. Porter, 760 P.2d 816 (Okla. 1988); (2) declared caps on dramshop liability unconstitutional, Richardson v. Carnegie Library Restaurant, Inc., 107 N.M. 688, 763 P.2d 1153 (1988), McGuire v. C & L Restaurant, Inc., 346 N.W.2d 605 (Minn. 1984); (3) declared a limitation on recovery against state entities unconstitutional, Condemarin v. University Hospital, 775 P.2d 348 (Utah 1989); (4) upheld a $250,000 limitation on damages for pain and suffering, Samsel v. Wheeler Transport Services, 244 Kan. 726, 771 P.2d 71 (1989); (5) upheld a $200,000 limit on recovery against charitable organizations, Doe v. American Red Cross Blood Services, 297 S.C. 430, 377 S.E.2d 323 (1989); and (6) upheld prohibition of noneconomic damages and restriction of punitive damages in wrongful discharge cases, Meech v. Hillhaven West, Inc., 776 P.2d 488 (Mont.1989).
. LSA-R.S. 40:1299.42.
. LSA-R.S. 40:1299.42B(2).
. Act No. 435 of 1984; LSA-R.S. 40:1299.43.
. The doctor was released together with all "related companies and/or parties and employees...." The language apparently referred to Dr. Herman R. Cohen, with whom Dr. Kushner operated "A Professional Medical Corporation." Dr. Cohen and the corporation were not included in the later proceedings.
. Williams on Behalf of Williams v. Kushner, 449 So.2d 455 (La.1984).
. Sibley v. Board of Sup'rs of Louisiana State University, 477 So.2d 1094 (La. 1985).
. Williams v. Kushner, 524 So.2d 191 (La.App. 4th Cir.1988).
. 526 So.2d 785 (La. 1988).
. See also Prendergast v. Nelson, 199 Neb. 97, 256 N.W.2d 657 (1977).
. Act 239 of 1985: LSA-R.S. 40:1299.39.
. LSA-Const. Art. I, § 3 provides:
No person shall be denied the equal protection of the laws. No law shall discriminate against a person because of race or religious ideas, beliefs, or affiliations. No law shall arbitrarily, capriciously, or unreasonably discriminate against a person because of birth, age, sex, culture, physical condition, or political ideas or affiliations. Slavery and involuntary servitude are prohibited, except in the latter case as punishment for crime.
.See Appendix I.
. Compare Sibley v. Board of Sup'rs of Louisiana State University, All So.2d 1094 (La.1985).
. The medical malpractice legislation was repealed but Idaho now has a $400,000 ceiling on all noneconomic damages.
.811 F.2d 270 (5th Cir.1987).