Court Opinion

ID: 9662941
Source: CourtListenerOpinion
Date Created: 2023-08-23 23:23:51.738511+00
Date Added: 2024-06-11T18:14:44.117793
License: Public Domain

McCormack, J.,
concurring in part, and in part dissenting.
I agree with those portions of this court’s per curiam opinion discussing the jury verdict, the life care plan, “What to Expect When You’re Expecting,” and the Gourleys’ attempted cross-appeal. However, I respectfully dissent from the per curiam opinion’s analysis of the constitutionality of Neb. Rev. Stat. § 44-2825(1) (Reissue 1998) (the cap). I would find that the cap is special legislation in violation of Neb. Const, art. Ill, § 18.

PRENDERGAST V. NELSON

As recognized by the per curiam opinion, this court previously addressed the constitutionality of various provisions of the Nebraska Hospital-Medical Liability Act in Prendergast v. Nelson, 199 Neb. 97, 256 N.W.2d 657 (1977). I respectfully suggest that Prendergast is persuasive authority for next to nothing.
In Prendergast, a declaratory judgment action was brought by three health care providers against the director of the Nebraska Department of Insurance after the director refused to implement the provisions of the act. A three-judge plurality of this court upheld the constitutionality of numerous provisions of the act. Specifically, the plurality found that the cap was not an unconstitutional special privilege. Prendergast v. Nelson, supra. The plurality found it important that while a claimant who has not elected *973out of the act’s provisions may be limited in the amount of recovery, the claimant is guaranteed the existence of a fund from which to recover and is also guaranteed a procedure to provide an assessment of his or her claim. Prendergast v. Nelson, supra. The ability to elect out of the act’s provisions and the tradeoff of the amount of recovery for the assessment and certainty of recovery persuaded the plurality that the cap did not offend any constitutional prohibition on the passage of special legislation.
The plurality opinion authored by Justice Spencer is one of six opinions filed in the case and is the only opinion in which any member of the court found that the cap is constitutional. A review of several of the remaining opinions discloses the dubious procedural posture upon which the plurality made its findings.
Justice Clinton concurred with the plurality with respect to “[t]he only justiciable issue before the court,” i.e., whether the act granted the credit of the state in aid of an individual, association, or corporation under Neb. Const, art. XIII, § 3. Prendergast v. Nelson, 199 Neb. at 125, 256 N.W.2d at 674 (Clinton, J., concurring in part, and in part dissenting). As to the remaining issues, Justice Clinton admonished:
Today this court, to the best of my knowledge, for the first time in its history renders what is, for the most part, an advisory opinion. In this respect it lamentably disregards its constitutional functions as a court. This course, if followed in the future, has ominous implications for the future political welfare of this state.
Id. at 122, 256 N.W.2d at 672.
In addition to the suspect procedural posture of the case, Prendergast also resulted in a severely fractured court. While Justice Clinton declined to reach any constitutional issues not properly raised, Justice White found that the cap was unconstitutional special legislation. Id. (White, J., dissenting in part). Justice McCown concurred with Justice White’s opinion that the cap was unconstitutional special legislation. Id. (McCown, J., dissenting in part). Finally, Justice Boslaugh found that the election provision of the act — the saving grace of the cap according to the plurality — was “unrealistic and illusory.” Prendergast v. Nelson, 199 Neb. 97, 133, 256 N.W.2d 657, 677 (1977) (Boslaugh, J., dissenting in part).
*974The fractures and procedural defects in Prendergast noted above have not gone unnoticed by other states. The North Dakota Supreme Court has noted that Prendergast
is made less persuasive by the fact that the majority opinion is joined by only three of seven judges, with three others dissenting as to the constitutionality of a $500,000 limitation on recovery, and one judge declining to reach constitutional questions, since he questions the standing of some of the parties and concludes that the opinion is only advisory.
Arneson v. Olson, 270 N.W.2d 125, 131 (N.D. 1978). See, also, Lucas v. U.S., 757 S.W.2d 687 (Tex. 1988); Fein v. Permanente Medical Group, 38 Cal. 3d 137, 695 P.2d 665, 211 Cal. Rptr. 368 (1985) (Bird, C.J., dissenting).
A court has the power neither to render advisory opinions nor to decide questions that cannot affect the rights of litigants in the case before it. Preiser v. Newkirk, 422 U.S. 395, 95 S. Ct. 2330, 45 L. Ed. 2d 272 (1975). The director of the Department of Insurance admittedly represented no person in Prendergast who was limited in the amount he or she could recover against a health care provider or whose constitutional rights were otherwise affected by the provisions of the act. Prendergast v. Nelson, supra (Clinton, J., concurring in part, and in part dissenting). Despite the lack of a concrete adversarial claim, a plurality of the court ventured forth to address whether the cap, evidently as applied to some hypothetical claimant, was constitutional. The present case suffers from no such defect. For the first time, the constitutionality of the cap has been presented to this court by parties with their own rights at stake. The Gourleys were awarded damages against Knolla and the OB/GYN Group in an amount exceeding the cap and now seek a determination that the cap is unconstitutional so that they may recover the full amount of their damages. The rights of the Gourleys and of Knolla and the OB/GYN Group are squarely at issue in this case.
The doctrine of stare decisis would typically require us to abide by the Prendergast decision and uphold the constitutionality of the cap, see Metro Renovation v. State, 249 Neb. 337, 543 N.W.2d 715 (1996), “ ‘ “ ‘unless the reasons therefor have ceased to exist, are clearly erroneous, or are manifestly wrong and mischievous or unless more harm than good will result from doing so,””” *975(emphasis in original) State v. Reeves, 258 Neb. 511, 527-28, 604 N.W.2d 151, 163 (2000). The U.S. Supreme Court describes stare decisis as a principle of policy rather than an inexorable command. Hohn v. United States, 524 U.S. 236, 118 S. Ct. 1969, 141 L. Ed. 2d 242 (1998). Where a fractured decision of this court rests upon tenuous procedural grounds, and where the current case presents clear adversaries serving to sharply focus the constitutional issues, I believe it would be a disservice to the parties to pronounce a decision based upon a case as ill-advised as Prendergast. Thus, I visit the issue anew.
SPECIAL LEGISLATION
Neb. Const, art. Ill, § 18, provides:
The Legislature shall not pass local or special laws in any of the following cases, that is to say:
Granting to any corporation, association, or individual any special or exclusive privileges, immunity, or franchise whatever .... In all other cases where a general law can be made applicable, no special law shall be enacted.
By definition, a legislative act is general, and not special, if it operates alike on all persons of a class or on persons who are brought within the relations and circumstances provided for and if the classification so adopted by the Legislature has a basis in reason and is not purely arbitrary. Haman v. Marsh, 237 Neb. 699, 467 N.W.2d 836 (1991). A legislative act that applies only to particular individuals or things of a class is special legislation. Id. General laws embrace the whole of a subject, with their subject matter of common interest to the whole state. Uniformity is required in order to prevent granting to any person, or class of persons, the privileges or immunities which do not belong to all persons. Id. It is because the legislative process lacks the safeguards of due process and the tradition of impartiality which restrain the courts from using their powers to dispense special favors that such constitutional prohibitions against special legislation were enacted. Id.
A legislative act constitutes special legislation, violative of Neb. Const, art. Ill, § 18, if (1) it creates an arbitrary and unreasonable method of classification or (2) it creates a permanently *976closed class. Bergan Mercy Health Sys. v. Haven, 260 Neb. 846, 620 N.W.2d 339 (2000). My focus is solely on whether the cap creates an arbitrary and unreasonable method of classification.
A legislative classification, in order to be valid, must be based upon some reason of public policy, some substantial difference of situation or circumstances, that would naturally suggest the justice or expediency of diverse legislation with respect to the objects to be classified. Id. Classifications for the purpose of legislation must be real and not illusive; they cannot be based on distinctions without a substantial difference. Id. When the Legislature confers privileges on a class arbitrarily selected from a large number of persons standing in the same relation to the privileges, without reasonable distinction or substantial difference, then the statute in question has resulted in the kind of improper discrimination prohibited by the Nebraska Constitution. Id.
In Haman v. Marsh, 237 Neb. at 713, 467 N.W.2d at 846-47, we had the opportunity to describe this test in greater detail:
The narrower special legislation prohibition supplements the equal protection theory. . . . The test of validity under the special legislation prohibition is more stringent than the traditional rational basis test. Classifications must be based on some substantial difference of situation or circumstances that would naturally suggest the justice or expediency of diverse legislation with respect to the objects to be classified.
(Citation omitted.) (Emphasis in original.)
The above-quoted portion of Haman was necessary to resolve some confusion about the exact nature of the test and its relationship to the test applied in an equal protection case. The tests applied in an equal protection case are well known. If a statute involves economic or social legislation not implicating a fundamental right or suspect class, courts will ask only whether a rational relationship exists between a legitimate state interest and the statutory means selected by the Legislature to accomplish that end. Schindler v. Department of Motor Vehicles, 256 Neb. 782, 593 N.W.2d 295 (1999). The party challenging a statute’s constitutionality has the burden to show that the statute has no rational basis. See Hall v. Progress Pig, Inc., 259 Neb. 407, 610 N.W.2d 420 (2000). Upon a showing that such a rational relationship *977exists, courts will uphold the legislation. Schindler v. Department of Motor Vehicles, supra. The intermediate scrutiny test requires that a party seeking to uphold a statute that classifies individuals must show that the classification serves important governmental objectives and that the discriminatory means employed are substantially related to achievement of those objectives. See Mississippi University for Women v. Hogan, 458 U.S. 718, 102 S. Ct. 3331, 73 L. Ed. 2d 1090 (1982). See, also, Friehe v. Schaad, 249 Neb. 825, 545 N.W.2d 740 (1996). Finally, if a legislative classification involves either a suspect class or a fundamental right, courts will analyze the statute with strict scrutiny. Under this test, strict congruence must exist between the classification and the statute’s purpose. The end the Legislature seeks to effectuate must be a compelling state interest, and the means employed in the statute must be such that no less restrictive alternative exists. Schindler v. Department of Motor Vehicles, supra.
In Haman v. Marsh, 237 Neb. 699, 713, 467 N.W.2d 836, 846 (1991), we described special legislation as being a “narrower” test than equal protection. We further explained that “[t]he test of validity under the special legislation prohibition is more stringent than the traditional rational basis test.” (Emphasis supplied.) Id. at 713, 467 N.W.2d at 846-47. See, also, City of Ralston v. Balka, 247 Neb. 773, 530 N.W.2d 594 (1995). The level of scrutiny required by the above-mentioned test is “more stringent” because of the requirement that classifications be based upon some “substantial” difference of situation or circumstances. (Emphasis in original.) Haman v. Marsh, 237 Neb. at 713, 467 N.W.2d at 847. See, also, City of Ralston v. Balka, supra; MAPCO Ammonia Pipeline v. State Bd. of Equal., 238 Neb. 565, 471 N.W.2d 734 (1991) (emphasizing that classifications must be based upon some substantial difference of situation or circumstances); State ex rel. Douglas v. Marsh, 207 Neb. 598, 300 N.W.2d 181 (1980).
Because the test of validity under the special legislation prohibition is more stringent than the traditional rational basis test, I would apply a level of scrutiny comparable to the intermediate scrutiny test. It is well known that the degree of judicial scrutiny to which the statute is to be subjected may be dispositive. See Schindler v. Department of Motor Vehicles, supra. *978That has proved to be the case in other states that have analyzed caps. Those states that have subjected caps to the minimal rational basis test have, as one might expect, found their caps to be constitutional. See, Evans ex rel. Kutch v. State, 56 P.3d 1046 (Alaska 2002); Fein v. Permanente Medical Group, 38 Cal. 3d 137, 695 P.2d 665, 211 Cal. Rptr. 368 (1985); Scholz v. Metropolitan Pathologists, P.C., 851 P.2d 901 (Colo. 1993) (en banc); Leliefeld v. Johnson, 104 Idaho 357, 659 P.2d 111 (1983); Johnson v. St. Vincent’s Hospital, 273 Ind. 374, 404 N.E.2d 585 (1980), abrogated on other grounds, Collins v. Day, 644 N.E.2d 72 (Ind. 1994); Murphy v. Edmonds, 325 Md. 342, 601 A.2d 102 (1992); Phillips v. Mirac, Inc., 251 Mich. App. 586, 651 N.W.2d 437 (2002); Adams v. Children’s Mercy Hosp., 832 S.W.2d 898 (Mo. 1992) (en banc); Morris v. Savoy, 61 Ohio St. 3d 684, 576 N.E.2d 765 (1991); Matter of Certif. of Questions of Law, 544 N.W.2d 183 (S.D. 1996); Etheridge v. Medical Center Hospitals, 237 Va. 87, 376 S.E.2d 525 (1989); Robinson v. Charleston Area Med. Center, 186 W. Va. 720, 414 S.E.2d 877 (1991); Guzman v. St. Francis Hospital, Inc., 240 Wis. 2d 559, 623 N.W.2d 776 (Wis. App. 2000). However, caps have generally been unable to survive a more stringent level of scrutiny. See, Moore v. Mobile Infirmary Ass’n, 592 So. 2d 156 (Ala. 1991); Arneson v. Olson, 270 N.W.2d 125 (N.D. 1978); Carson v. Maurer, 120 N.H. 925, 424 A.2d 825 (1980); Condemarin v. University Hosp., 775 P.2d 348 (Utah 1989). But see Jones v. State Board of Medicine, 97 Idaho 859, 555 P.2d 399 (1976).
In analyzing a special legislation claim, we must determine (1) the privilege created by the statute, (2) the particular class which is singled out to receive the privilege, (3) the persons within the general class that is made the subject of the legislation who stand in the same relation to the privilege as the particular class, and (4) whether a substantial difference exists between the particular class and the general class. See Bergan Mercy Health Sys. v. Haven, 260 Neb. 846, 620 N.W.2d 339 (2000) (Hendry, C.J., dissenting).
The cap grants a privilege to all health care providers whose negligence causes catastrophic damages, i.e., damages in excess of $1,250,000, because they are liable for less than 100 percent *979of the damages they cause. The general class standing in the same relation to these health care providers is all other professional service providers who commit malpractice and cause catastrophic damages and who are liable for 100 percent of the damages they cause. Is there a substantial difference between these two classes? I do not believe that there is. Each class provides services to the public. Each class is subject to actions brought by the public for malpractice committed in the course of providing those services to the public. Each class is financially burdened by those actions which prove to be successful. Each class may impose the costs of those successful actions on the public at large. Yet the Legislature has chosen to provide a benefit to one subset of the general class by exempting those health care providers whose negligence causes damages in excess of $1,250,000 from full liability for their negligent actions. Thus, I conclude that the cap is unconstitutional special legislation in violation of Neb. Const, art. Ill, § 18.
As Justice Gerrard discusses in greater detail, I am equally concerned by the fact that the cap applies to all damages, whether economic or noneconomic. Several states have struck down statutes that impose a cap on all damages. Wright v. Central Du Page Hosp. Ass’n, 63 Ill. 2d 313, 347 N.E.2d 736 (1976); Arneson v. Olson, supra; State ex rel. OATL v. Sheward, 86 Ohio St. 3d 451, 715 N.E.2d 1062 (1999); Lucas v. U.S., 757 S.W.2d 687 (Tex. 1988). The majority of states with caps in effect today limit only the noneconomic damages a person may recover and do not limit recovery for economic damages. See Mark D. Clore, Medical Malpractice Death Actions: Understanding Caps, Stowers, and Credits, 41 S. Tex. L. Rev. 467, appendix A (2000). As the per curiam opinion notes, evidence offered at trial indicates that the Gourleys’ economic damages, reduced to present value, is a minimum of $5,943,111. The jury failed to award even this amount, instead awarding $5 million in economic damages and $625,000 in noneconomic damages. However, by applying the cap and slashing the Gourleys’ award to $1,250,000, the Gourleys receive an award which will cover only a fraction of their expenses over the course of Colin’s lifetime and, in effect, receive nothing for their pain and suffering. See Arneson v. Olson, 270 N.W.2d 125 (N.D. *9801978). If Nebraska followed the majority of states with caps that limited only noneconomic damages, the Gourleys would have been able to recover a large percentage of the expenses they will be burdened with for the rest of Colin’s life. Had a valid challenge to the cap been preserved on substantive due process grounds, I would find that the cap violates that constitutional mandate as well for the reasons expressed by Justice Gerrard in his concurring opinion.
One of the stated purposes of the Nebraska Hospital-Medical Liability Act is to “[ejnsure the availability of malpractice insurance coverage at reasonable rates.” Neb. Rev. Stat. § 44-2801(2) (Reissue 1998). As the per curiam opinion states, “the proponents of the act expressed concern that an insurance crisis existed, but admitted that it was likely impossible to know if a cap on damages would solve the problem. Based on the information before it, the Legislature generally believed that a damages cap would solve the problem____” Now, 27 years after enactment of the cap, the information available indicates otherwise.
The following is a comparison of the base rates for physicians’ liability insurance available in several states from various insurance companies for three different specialties: internal medicine, general surgery, and obstetrics-gynecology (OB/GYN). The data was obtained from Trends in 2002 Rates for Physicians’ Medical Professional Liability Insurance (Med. Liab. Monitor 2002) (see, generally, http://www.medicalliabilitymonitor.com).
STATE 2001 RATE 2002 RATE b INCREASE SINCE 7/01
NEBRASKA
Midwest Medical Insurance Co.:
Internal Medicine $ 3,183 $ 3,469 9.0%
General Surgery 11,301 12,318 9.0
OB/GYN 17,297 18,854 9.0
PIC Wisconsin:
Internal Medicine $ 2,256 $ 2,786 23.4%
General Surgery 7,114 9,474 33.1
OB/GYN 12,288 16,718 36.0
CALIFORNIA
Cooperative of American Physicians:
Internal Medicine $ 7,710 $ 9,070 17.6%
(So. Calif.)
*981Internal Medicine 7,340 8,630 17.6
(San Diego)
Internal Medicine 6,590 7,750 17.6
(No. Calif.)
General Surgery 24,740 25,330 2.4
(So. Calif.)
General Surgery 23,520 24,080 2.4
(San Diego)
General Surgery 21,070 21,570 2.4
(No. Calif.)
OB/GYN 42,330 43,350 2.4
(So. Calif.)
OB/GYN 40,230 41,200 2.4
(San Diego)
OB/GYN 36,020 36,890 2.4
(No. Calif.)
Northwest Physicians Mutual Insurance Co.:
Internal Medicine $ 9,204 $ 9,810 6.6%
(Los Angeles)
Internal Medicine 7,592 8,092 6.6
(San Diego)
Internal Medicine 6,240 6,650 6.6
(No. Calif. & rest of state)
General Surgery 25,080 30,704 22.4
(Los Angeles)
General Surgery 20,879 24,073 15.3
(San Diego)
General Surgery 17,783 20,448 15.0
(No. Calif. & rest of state)
OB/GYN 46,938 56,406 20.1
(Los Angeles)
OB/GYN 38,721 43,776 13.1
(San Diego)
OB/GYN 33,226 37,238 12.1
(No. Calif. & rest of state)
COLORADO
COPIC Insurance Co.:
Internal Medicine $ 9,324 $ 9,845 5.6%
General Surgery 32,804 34,644 5.6
OB/GYN 29,265 30,905 5.6
Doctors’ Co.:
Internal Medicine $ 8,482 $ 8,876 14.8%
General Surgery 29,906 32,657 14.8
OB/GYN 38,578 39,494 14.8
*982FLORIDA
First Professionals Insurance Co.:
Internal Medicine $ 38,378 $ 56,153 46.3%
(Dade Cty.)
Internal Medicine 19,681 28,796 46.3
(rest of state)
General Surgery 124,046 174,268 40.5
(Dade Cty.)
General Surgery 63,614 89,368 40.5
(rest of state)
OB/GYN 166,368 201,376 21.0
(Dade Cty.)
OB/GYN 85,317 103,270 21.0
(rest of state)
Medical Assurance Co.:
Internal Medicine $17,611 $26,794 52.1%
(Dade, Broward Ctys.)
Internal Medicine 10,232 15,460 51.1
(rest of state)
General Surgery 63,189 95,474 51.1
(Dade, Broward Ctys.)
General Surgery 36,277 54,677 50.7
(rest of state)
OB/GYN 108,043 136,231 26.1
(Dade, Broward Ctys.)
OB/GYN 61,908 77,949 25.9
(rest of state)
American Physicians Assurance Corp.:
Internal Medicine $ 30,272 $ 49,494 63.5%
(Dade Cty.)
Internal Medicine 15,136 23,757 57.0
(rest of state)
General Surgery 75,164 117,201 55.9
(Dade Cty.)
General Surgery 37.582 56,256 49.7
(rest of state)
OB/GYN 159,166 210,576 32.3
(Dade Cty.)
OB/GYN 79.583 101,076 27.0
(rest of state)
IDAHO
Doctors’ Co.:
Internal Medicine $ 7,389 17.9%
General Surgery 27,546 17.9
OB/GYN 32,262 17.9
*983Medical Insurance Exchange of California:
Internal Medicine $ 4,320 $ 4,320 0.0%
General Surgery 15,544 15,544 0.0
OB/GYN 25,904 25,904 0.0
IOWA
American Physicians Assurance Corp.:
Internal Medicine $ 4,374 $ 4,374 0.0%
General Surgery 14,386 14,386 0.0
OB/GYN 27,839 27,839 0.0
Doctors’ Co.:
Internal Medicine — $ 9,169 29.1%
General Surgery ■ — 30,441 29.1
OB/GYN — 39,852 29.1
Midwest Medical Insurance Co.:
Internal Medicine $ 5,412 $ 6,168 14.0%
General Surgery 16,325 18,607 14.0
OB/GYN 33,237 37,883 14.0
KANSAS
Kansas Medical Mutual Insurance Co.:
Internal Medicine $ 5,234 $ 6,082 16.2%
General Surgery 21,343 24,801 16.2
OB/GYN 33,082 38,441 16.2
Medical Assurance Co.:
Internal Medicine $ 3,522 $ 3,522 0.0%
General Surgery 14,090 14,090 0.0
OB/GYN 21,839 21,839 0.0
NORTH DAKOTA
Doctors’ Co.:
Internal Medicine — $ 6,712 0.8%
General Surgery — 18,006 0.8
OB/GYN — 25,071 0.8
Midwest Medical Insurance Co.:
Internal Medicine $ 4,719 $ 5,427 15.0%
General Surgery 12,583 14,470 15.0
OB/GYN 21,628 24,872 15.0
SOUTH DAKOTA
Doctors’ Co.:
Internal Medicine — $ 5,395 19.7%
General Surgery — 19,958 19.7
OB/GYN — 23,950 19.7
Midwest Medical Insurance Co.:
Internal Medicine $ 2,527 $ 2,906 15.0%
General Surgery 6,737 7,748 15.0
OB/GYN 11,580 13,317 15.0
*984The statistics cited above indicate a general upward trend in malpractice rates in Iowa and North Dakota — states that do not cap damages in medical malpractice actions. Belying the story line advanced by cap proponents, however, the same general upward trend is exhibited in states with caps, such as Nebraska, California, Colorado, Florida, Idaho, Kansas, and South Dakota. It appears that at least one of the intended goals of caps, to ensure reasonable malpractice rates, remains unmet — unfortunate news to the catastrophically injured such as Colin and his family, who can recover only approximately 20 percent of their medical costs so that some medical providers can enjoy what they consider to be reasonable rates. And while the absolute amount for malpractice insurance may, in some states, be burdensome, the data available suggests that insurance rates are not so “practically prohibitive,” as we stated in Taylor v. Karrer, 196 Neb. 581, 586, 244 N.W.2d 201, 204 (1976), disapproved on other grounds, Jorgensen v. State Nat. Bank & Trust Co., 255 Neb. 241, 583 N.W.2d 331 (1998), relative to physicians’ incomes, as seen from the following data compiled by the American Medical Association:
GENERAL PRACTICE:
MEAN MEDIAN
Gross Revenue $457,800 $369,000
Professional Expenses 263,000 184,000
Professional Liability 10,900 7,000
Income After All Expenses Including Malpractice Premiums 142,500 130,000
GENERAL INTERNAL MEDICINE:
MEAN MEDIAN
Gross Revenue $419,400 $357,000
Professional Expenses 225,900 160,000
Professional Liability 10,800 6,000
Income After All Expenses Including Malpractice Premiums 157,900 140,000
INTERNAL MEDTCINE-CARDIOLOGY:
MEAN MEDIAN
Gross Revenue $689,200 $676,000
Professional Expenses 381,700 313,000
*985Professional Liability 27,100 12,000
Income After All Expenses Including Malpractice Premiums 294,600 230,000
SURGERY-GENERAL:
MEAN MEDIAN
Gross Revenue $454,100 $359,000
Professional Expenses 201,700 131,000
Professional Liability 24,900 23,000
Income After All Expenses Including Malpractice Premiums 246,800 215,000
SURGERY-ORTHOPEDIC:
MEAN MEDIAN
Gross Revenue $748,500 $668,000
Professional Expenses 417,100 324,000
Professional Liability 34,200 28,000
Income After All Expenses Including Malpractice Premiums 312,500 280,000
OB/GYN:
MEAN MEDIAN
$627,000 $515,000 Gross Revenue
375,900 272,000 Professional Expenses
35,800 33,000 Professional Liability
Income After All Expenses Including Malpractice Premiums 214,400 200,000
Physician Socioeconomic Statistics 2000-2002 (John D. Wassenaar and Sara L. Thran, eds., Am. Med. Assn. 2001). While the income figures cited above are based on a nationwide sample of physicians, the study noted that “[geographic differences in income are less pronounced than for other” categories tabulated. James W. Moser, Physician Income Trends, in Physician Socioeconomic Statistics 2000-2002, supra.
I respectfully dissent from the per curiam opinion’s conclusion that the cap is constitutional.