Opinion ID: 1855860
Heading Depth: 1
Heading Rank: 4

Heading: Caps Under the MLSSA

Text: In support of its holding that only one statutory cap applies to all injuries under the MLSSA, the court of appeal relied upon this court's decision in Conerly v. State, 97-0871 (La.7/8/98); 714 So.2d 709. In Conerly, there were two claims, a wrongful death claim and a survival action, arising from a single act of malpractice. We held: [When] there is an act of malpractice causing the death of a patient, and plaintiffs bring survival and wrongful death claims, La. R.S. 40:1299.39 provides there is but one $500,000 cap applicable to all claims. Id. at 714. In reasoning that only one cap applied, we examined the language of the statute, and found that the legislature intended for the Act to limit the State's liability for one act of malpractice to $500,000.00. In Conerly, we did not address the issue presented here of whether separate caps would apply to separate acts of negligence. Although this court has discussed the issue of whether more than one cap could apply to multiple acts of malpractice, the issue has never been squarely presented. In Turner v. Massiah, 94-2548 (La.8/30/95); 656 So.2d 636, where two physicians failed to diagnose the plaintiffs breast cancer, we stated: If the damage or injury could have been divided into two parts, one part caused by one defendant and the other part caused by the other, there would have been, in effect, two injuries. In that case, there having been two torts and two injuries, the question of two caps might have been present. In this case, there were two torts but only one injury. Id. at 640. We held that the total amount recoverable was $500,000, as the patient suffered but one injury. In dicta, the court favorably discussed Justice Dennis' concurrence/dissent in Stuka v. Fleming, 561 So.2d 1371 (La.1990), cert. denied 498 U.S. 982, 111 S.Ct. 513, 112 L.Ed.2d 525 (1990) [3] , where he stated: I am reluctant to conclude that the Fund may never be made to pay more than $400,000 for injuries contributed to by more than one health care provider-tortfeasor. Whether a single limitation applies to damages caused by plural defendants may depend on such factors as whether the defendants engaged in concerted action, whether the damages are severable, or whether the damages may be apportioned between the tortfeasors. Stuka supra (Dennis, J., concurring in part, dissenting in part). In Conerly, supra, an infant sustained a severe brain injury and kidney failure at birth, and the parents filed a medical malpractice action, seeking damages for the infant's injuries. When the child died at age four, the parents amended the lawsuit to add two claims, one a survival action and the other a wrongful death claim. The court found there was only one act of malpractice. In this case, Ms. Batson's injuries can be divided into three major events or injuries: sepsis, decubitus ulcers, and flexion contractures. The sepsis was caused by the physicians' failure to invoke preventative measures and to timely diagnose and treat the sepsis. The decubitus ulcers were caused by the nursing staffs failure to take preventative measures to prevent formation of the ulcers and to timely detect their early development. The flexion contractures were caused by the orthopedic staffs and/ or physical therapists' failure to order and/or perform adequate treatment. Thus, there are three torts, three groups of tortfeasors, and three injuries. This case squarely presents the issue of whether the MLSSA allows for awarding a plaintiff multiple caps for multiple acts of malpractice and separate injuries. We treat legislation as the solemn expression of legislative will, and therefore, interpretation of a law involves primarily the search for the legislature's intent. LSA-C.C. art. 1; Ruiz v. Oniate, 97-2412 (La.5/19/98); 713 So.2d 442; Hutchinson v. Patel, 93-2156 (La.5/23/94); 637 So.2d 415. When a law is clear and unambiguous and its interpretation does not lead to absurd consequences, the law shall be applied as written, and no further interpretation may be made in search of the intent of the legislature. La. C.C. art. 9; Ruiz, supra, Hutchinson, supra . Malpractice actions brought against the state in connection with services rendered by state facilities are governed by the MLSSA. The MLSSA was enacted in 1976 to provide that the State of Louisiana would pay any damages awarded in a medical malpractice suit instituted against certain state-employed health-care providers. This court has noted that the Act must be strictly construed because it grants immunity or advantages to special classes in derogation of general rights available to tort victims. See Conerly, supra ; Ruiz supra ; Kelty v. Brumfield, 93-1142 (La.2/25/94); 633 So.2d 1210, reh'g denied, 93-1142 (La.3/25/94); 635 So.2d 247. The pertinent language of the MLSSA to the issue presented herein is as follows: Notwithstanding any other provision of the law to the contrary, no judgment shall be rendered and no settlement or compromise shall be entered into for the injury or death of any patient in any action or claim for an alleged act of malpractice in excess of five hundred thousand dollars plus interest and costs, exclusive of future medical care and related benefits valued in excess of such hundred thousand dollars. LSA-R.S. 40:1299.39(F). The legislative intent of LSA-R.S. 40:1299.39 can be gleaned from a careful reading of Sections C and D of the statute. Section C provides: Since the Louisiana Civil Code was enacted only in the domain of the private law, governs only the legal relationships of private persons among themselves alone, and is inapplicable to public entities and their legal relationships, there is no right nor legal basis ex delicto, or ex quasi-delicto, for an action by a patient or his representative to recover damages or any other losses, including those for the death of the patient, from the state or a state health care provider as defined in this Section as a result of malpractice in connection with state-provided or state-related health care; however, a patient, his representative properly acting for him, or his after-death representative shall have a right to recover from the state certain losses to the extent and within the limitations defined and allowed by this Section of public law due to malpractice as defined in this Section, in the circumstances and within the parameters provided by this Section, on the sole basis of this Section as a special substantive sui generis statutory grant in the domain of public law. This Section shall not be construed to limit, waive, or prohibit claims for lack of informed consent or breach of contract as defined by statutes or otherwise provided by law. Section D provides, in pertinent part: (1) Whenever in the same circumstances, but not more than to the same extent, that a patient would, under the private law, including the Louisiana Civil Code, which is applicable only to private persons among themselves alone, be allowed a recovery, due to malpractice, from a private person not employed by nor acting on behalf of a public entity, a patient, his representative properly acting for him, or his after-death representative shall have a right to recover, from the state, losses, including the death of said patient, but only to the degree and within the limits allowed by, and subject to the terms and conditions of, this Section of public law, when and insofar as such losses proximately result from malpractice as defined in this Section ... Section C makes it clear that because private law is inapplicable to public entities, the legislature enacted the MLSSA to perform the same function for public entities as the private act does for private qualified health care providers. Both acts limit the amount plaintiffs can recover in actions for damages under LSA-C.C. art. 2315 for medical malpractice to the respective caps set forth in those acts. We hold that the MLSSA does not foreclose the possibility of a plaintiff recovering more than one cap for multiple injuries resulting from multiple acts of malpractice. The MLSSA limits recovery to $500,000.00 for  the injury  for  an alleged act of malpractice. The use of the singular nouns injury and act denotes that the legislature did not intend to limit a plaintiff to one recovery for multiple injuries resulting from multiple acts of malpractice. The plain language of the Act gives no indication that a plaintiff should be limited to a single recovery of $500,000.00, irrespective of how many acts of malpractice are performed against him or her. The language of LSA-R.S. 40:1299.39(F) should be interpreted to indicate by inference that the total amount recoverable for each act of malpractice shall not exceed $500,000.00. To hold that a plaintiff can only recover one cap regardless of how many times he or she is the victim of malpractice would imply that when a person enters a hospital and is the victim of an initial act of malpractice, all other health care providers have free reign to commit any number of additional negligent acts with full immunity. Clearly, the legislature did not intend such an outrageous result.