Opinion ID: 1496754
Heading Depth: 1
Heading Rank: 6

Heading: Sax and Article 4590i, Section 11.02

Text: Under Sax , the test for determining the constitutionality of a restriction of an individual's right to redress is whether the legislative basis for the statute outweighs the denial of the constitutionally-guaranteed right of redress. Sax, 648 S.W.2d at 665. See also Nelson v. Krusen, 678 S.W. 2d at 922 (citing Hanks v. City of Port Arthur, 121 Tex. 202, 48 S.W.2d 944 (1932) and McCrary v. City of Odessa, 482 S.W. 2d 151 (Tex.1972)). In applying this test, we consider both the general purpose of the statute and the extent to which the litigant's right to redress is affected. Sax at 666. Legislative action withdrawing or restricting a common law remedy will be sustained if it is reasonable in substituting other remedies. Sax at 665 (citing Lebohm ). I believe the stated purposes for enacting the Medical Liability and Insurance Improvement Act demonstrates that the legislature acted reasonably under this standard. Two of the stated purposes of article 4590i are to: (4) make available to physicians, hospitals, and other health care providers protection against potential liability through the insurance mechanism at reasonable affordable rates; (5) make affordable medical and health care more accessible and available to the citizens of Texas; . . . . TEX.REV.CIV.STAT.ANN. art. 4590i, § 1.02(b) (Vernon Supp.1988). Although an individual quid pro quo is not constitutionally required, I nonetheless submit these two purposes reveal that the medical cap in section 11.02 of article 4590i provides both a societal and individual quid pro quo. The benefit to society is that by reducing the awards given to those injured in excess of the caps, insurance payouts are more readily calculable. This in turn allows a predictable rate structure to be erected, thus allowing policies to be written on health care providers who otherwise could not afford the exorbitant rates associated with policies of undeterminable risk. The resultant societal quid pro quo is the decrease in cost of medical malpractice insurance in the state of Texas and the increased availability of health care. I further suggest there is an individual quid pro quo because the caps enable health care providers to procure insurance in the first place. Without adequate coverage, it was reasonable for the Legislature to conclude that the plaintiff in a medical malpractice case would suffer damages with no recovery at all against an insolvent, judgment-proof defendant. I submit that a recovery of all medical costs and expenses, with a cap on $500,000 plus a Consumer Price Index adjustment on other damages, is better than a potential recovery of zero. Thus, while a reasonable substitute should not be required for legislative modifications of causes of action, I suggest there is in fact a sufficient quid pro quo in this case. I agree with the position taken by the California Supreme Court: [E]ven if due process principles required some quid pro quo to support the statute, it would be difficult to say that the preservation of a viable medical malpractice insurance industry in this state was not an adequate benefit for the detriment the legislation imposes on malpractice plaintiffs. Fein v. Permanente Medical Group, 38 Cal.3d 137, 160, n. 18, 211 Cal.Rptr. 368, 385, n. 18, 695 P.2d 665, 681-82 n. 18 (1985). In determining whether a litigant's right of redress is unreasonably or arbitrarily restricted, four distinct characteristics of article 4590i must be emphasized. First, the medical malpractice claimant is allowed to recover all past and future medical expenses without limitation. Secondly, the plaintiff may recover up to $500,000 of nonmedical damages. Thirdly, the legislature provided for an upward adjustment of the damages limit based upon the Consumer Price Index. And fourth, the statute imposes a limitation on the liability of health care providers rather than an absolute ceiling on the amount a plaintiff can recover. Thus, where multiple defendants are involved, the medical malpractice plaintiff can recover against each. The statutory limits are applied on a per defendant basis rather than on a per occurrence basis. It is clear, therefore, that the Legislature was concerned with limiting the liability of each defendant, not with unreasonably and arbitrarily limiting the amount a plaintiff can recover. These aspects of the statute serve to distinguish it from all other state versions which have undergone constitutional attack.