Court Opinion

ID: 9640750
Source: CourtListenerOpinion
Date Created: 2023-08-22 17:14:30.527762+00
Date Added: 2024-06-11T18:10:32.609297
License: Public Domain

KILGARLIN, Justice.
This is the first case to come to us on questions certified by a federal appellate court. See Lucas v. United States, 807 F.2d 414 (5th Cir.1986), questions certified, 811 F.2d 270 (5th Cir.1987). Pursuant to Tex. Const, art. V, § 3-c, we have jurisdiction to answer the questions certified, which are as follows:
Whether the limitation on medical malpractice damages in Tex.Rev.Civ.Stat. Ann. art. 4590i §§ 11.02 and 11.03 (Vernon Supp.1986) is consistent with the Texas Constitution, and if so, whether it applies to limit the liability of each defendant rather than the recovery of each claimant.
For the reasons stated in this opinion, we answer that the damages limitations contained in sections 11.02 and 11.03 of article 4590i violate article I, § 13 of the Texas Constitution. It is therefore unnecessary for us to answer the additional question certified to us by the Fifth Circuit.
Our constitutional authority to answer questions of state law certified by federal appellate courts is of relatively recent origin. In 1985, Texas voters approved an amendment to our state constitution which became article V, section 3-c. The amendment became effective January 1,1986, and our court thereafter promulgated an implementing rule as authorized by the constitution. See Tex. Const, art. V., §§ 3-c(b) and 31; Tex.R.App.P. 114. Because this is the first case to come to us under the new certification procedures, for historical purposes we will first review briefly the steps employed by this court in considering the Fifth Circuit’s certification order and, ultimately, agreeing to answer the questions certified.
Upon receipt of the certified questions from the Fifth Circuit, the case was docketed and assigned a number in normal sequential order. Notice of the docketing was furnished the Attorney General, as required by Tex.R.App.P. 114(f) (the Attorney General did not intervene). Thereafter, the court, by majority vote, determined that it would accept the question and render an answer. At that time, the case *688was set for oral argument and the court determined to allow Lucas, who was urging the unconstitutionality of the statute, the role of petitioner even though the United States of America was the appealing party in the Fifth Circuit. Argument in the case was allowed as in any other cause before the court.
To put the facts of this case in perspective, we quote at length from the original opinion of the Fifth Circuit:
When fourteen-month-old Christopher Lucas developed a swollen neck and a fever after a family outing, his parents took him to the William Beaumont Army Medical Center near El Paso, Texas, for diagnosis and treatment. An army doctor determined that the child had a cyst in his thyroglossal duct and ordered an injection of 600,000 units of Bicillin LA, a penicillin product manufactured and packaged in its own syringe by Wyeth Laboratories.
A hospital nurse gave Christopher the shot in his right buttock with a 1 ¼" needle that was fully inserted. Christopher’s father testified that he saw a thin line of blood appear in the tube containing the medication when the nurse aspirated the plunger before injecting the medication into the baby. Blood appeared at the injection site, and within a few moments, Christopher’s legs became mottled. The doctors were summoned. They concluded that the baby was having an allergic reaction to the antibiotic and gave injections to combat it.
Several hours later, Christopher’s parents noticed that his legs were not moving as they usually did when he cried. Tests conducted during the next several days indicated paralysis. An operation to remove a tumor suspected to be pressing on the nerves controlling the child’s legs determined that the paralysis was the result of blood starvation of the nerves caused by a blockage created when the Bicillin LA was injected directly into an artery. Tragically, the paralysis is permanent.
Christopher and his parents sued the United States under the Federal Tort Claims Act. The district court held that the injection was negligently administered and awarded the parents $498,-628.72 as the present value of the past and future medical expenses they face in caring for Christopher until his majority. While the district court did not detail its calculation, the amount of the award is consistent with the total-offset method of discounting. The court also awarded to Christopher $350,000.00 as the present value of the future medical expenses he will have after his eighteenth birthday, and $600,000.00 as the present value of the impairment of his future earning capacity. Finally, the court awarded Christopher $1,500,000.00 for pain and suffering. The district court then reduced the award by the $400,000.00 paid by Weyth [sic] Labs to the Lucases in settlement of a state court suit.
The district court refused to apply Tex. Rev.Civ.Stat.Ann. art. 4590i (Vernon Supp.1986) to limit the nonmedical damages, stating that the provision did not apply to hospitals operated by the United States. In an amended judgment, the court ordered that interest on a judgment against the United States be paid only as it accrues after a claim is filed with the Comptroller General and not from the date of judgment. See 31 U.S. C. § 1304(b)(1)(A). The court awarded no damages for the parents’ separate claims for pain and suffering.
Lucas v. United States, 807 F.2d 414, 416 (5th Cir.1986), questions certified, 811 F.2d 270 (5th Cir.1987).
On appeal, the Fifth Circuit held that the liability limit of article 4590i, section 11.02, does apply to federally operated hospitals and that its application was consistent with the due process and equal protection clauses of the United States Constitution. 807 F.2d at 417, 421-22; 811 F.2d at 271. Our question, then, is whether the limits of liability for health care providers set out in that statute and/or section 11.03 are consistent with the Texas Constitution. Those sections provide in pertinent part:
Limit on Civil Liability
Sec. 11.02. (a) In an action on a health care liability claim where final *689judgment is rendered against a physician or health care provider, the limit of civil liability for damages of the physician or health care provider shall be limited to an amount not to exceed $500,000.
(b) Subsection (a) of this section does not apply to the amount of damages awarded on a health care liability claim for the expenses of necessary medical, hospital, and custodial care received before judgment or required in the future for treatment of the injury.
Alternative Partial Limit on Civil Liability
Sec. 11.03. In the event that Section 11.02(a) of this subchapter is stricken from this subchapter or is otherwise invalidated by a method other than through legislative means, the following shall become effective:
In an action on a health care liability claim where final judgment is rendered against a physician or health care provider, the limit of civil liability of the physician or health care provider for all past and future noneconomic losses recoverable by or on behalf of any injured person and/or the estate of such person, including without limitation as applicable past and future physical pain and suffering, mental anguish and suffering, consortium, disfigurement, and any other non-pecuniary damage, shall be limited to an amount not to exceed $150,000.
Tex.Rev.Civ.Stat.Ann. art. 4590i, §§ 11.02, 11.03. The limits in both sections are not absolute but instead increase or decrease depending on the consumer price index published by the federal government. Id. at §§ 11.01, 11.04.
At least thirteen states other than Texas have enacted damage limitation provisions into their medical malpractice statutes. Each statute has different characteristics, and the state courts have divided on the constitutionality of the various caps. See, e.g., Smith v. Department of Insurance, 507 So.2d 1080, 1087-89 (Fla.1987) ($450,-000 limit on noneconomic damages violated “open courts” provision of Florida Constitution); Wright v. Central Du Page Hospital Ass’n, 63 I11.2d 313, 347 N.E.2d 736, 743 (1976) ($500,000 cap constituted “special law” in violation of Illinois Constitution);1 Carson v. Maurer, 120 N.H. 925, 424 A.2d 825, 836-38 (1980) ($250,000 limit on nonec-onomic damages violated equal protection guaranteed by New Hampshire Constitution); Ameson v. Olson, 270 N.W.2d 125, 135-36 (N.D.1978) ($300,000 ceiling violated equal protection clause of North Dakota Constitution); Duren v. Suburban Community Hospital, 24 Ohio Misc.2d 25, 482 N.E.2d 1358, 1361-63 (C.P.1985) ($200,000 limit on general damages violated Ohio and federal constitutions); Fein v. Permanente Medical Group, 38 Cal.3d 137, 211 Cal. Rptr. 368, 695 P.2d 665, 679-84 (1985) ($250,000 ceiling on noneconomic damages held constitutional); Johnson v. St. Vincent Hospital, Inc., 273 Ind. 374, 404 N.E.2d 585, 598-601 (1980) ($500,000 cap upheld); Sibley v. Board of Supervisors, 462 So.2d 149, 154-58 (La.1985) ($500,000 cap upheld) modified on reh’g, 477 So.2d 1094, 1109-10 (La.1985) (latter opinion ordering conditional remand on state equal protection challenge); Prendergast v. Nelson, 199 Neb. 97, 256 N.W.2d 657, 668-69 (1977) ($500,000 cap upheld in plurality opinion joined by only three judges, with three others dissenting as to constitutionality, and one judge declining to reach constitutional issues because opinion was merely advisory). Compare Jones v. State Board of Medicine, 97 Idaho 859, 555 P.2d 399, 410-16 (1976), cert, denied, 431 U.S. 914, 97 S.Ct. 2173, 53 L.Ed.2d 223 (1977) (case remanded for fact findings pertinent to constitutional attacks on damage caps).
*690In Texas, at least three courts of appeals have already struck down the damages caps provided in article 4590i. Baptist Hospital of Southeast Texas, Inc. v. Baber, 672 S.W.2d 296 (Tex.App. — Beaumont 1984), writ refd n.r.e. per curiam, 714 S.W.2d 310 (Tex.1986); Brownsville Medical Center v. Gracia, 704 S.W.2d 68, 80 (Tex.App.—Corpus Christi 1985, writ refd n.r.e.); Detar Hospital, Inc. v. Estrada, 694 S.W.2d 359, 365-66 (Tex.App.—Corpus Christi 1985, no writ); Malone & Hyde, Inc. v. Hobrecht, 685 S.W.2d 739, 753 (Tex. App.—San Antonio 1985, writ dism’d by agr.). Another court of appeals has upheld the caps. Rose v. Doctors Hospital Facilities, 735 S.W.2d 244 (Tex.App.—Dallas 1987, writ granted). One federal district judge concluded that the Texas statute violates both the state and federal constitutions. Waggoner v. Gibson, 647 F.Supp. 1102 (N.D.Tex.1986). The certifying panel in our case, however, disagrees as to the federal constitution. See Lucas, 807 F.2d at 422 n. 2.
We begin our state constitutional analysis by noting the findings and purposes enumerated by the Texas Legislature in Tex.Rev.Civ.Stat.Ann. art. 4590i, § 1.02 (Vernon Supp.1987). Based on these findings and purposes, the legislature enacted the damages limitations quoted in section 11.02 and, alternatively, section 11.03. Significantly, section 11.03 on its face shows that the legislature itself entertained doubts about the constitutionality of the limit of liability set out in section 11.02(a).
We have considered the arguments for and against the constitutionality of the caps. With all respect due a legislative enactment, we nevertheless conclude that the liability limits in article 4590i, sections 11.02 and 11.03, are unconstitutional as applied to catastrophically damaged malpractice victims seeking a “remedy by due course of law.” Construing article I, section 13, of the Texas Constitution, this court has said:
In analyzing the litigant’s right to redress, we first note that the litigant has two criteria to satisfy. First, it must be shown that the litigant has a cognizable common law cause of action that is being restricted. Second, the litigant must show that the restriction is unreasonable or arbitrary when balanced against the purpose and basis of the statute.
Sax v. Votteler, 648 S.W.2d 661, 666 (Tex. 1983).
Texas courts have long recognized that victims of medical negligence have a well-defined common law cause of action to sue for injuries negligently inflicted upon them. This much is undisputed. Under Sax, then, the remaining inquiry is whether the restriction on Lucas’ right of recovery “is unreasonable or arbitrary when balanced against the purpose and basis of the statute” (emphasis added). We hold that the restriction is unreasonable and arbitrary and that article 4590i, sections 11.02 and 11.03, unconstitutionally limit Lucas’ right of access to the courts for a “remedy by due course of law.” Tex. Const, art. I, § 13. We note that there is no provision in the federal constitution corresponding to our constitution’s “open courts” guarantee. Indeed, that guarantee is embodied in Mag-na Carta and has been a part of our constitutional law since our republic.
Our first concern with the statute is that the legislature has failed to provide Lucas any adequate substitute to obtain redress for his injuries. See Sax, 648 S.W.2d at 667, citing Middleton v. Texas Power & Light Co., 108 Tex. 96,185 S.W. 556 (1915). As did the Supreme Court of Illinois, we reject any argument that the statute may be supported by alleged benefits to society generally:
Defendants argue that there is a societal quid pro quo in that loss of recovery potential to some malpractice victims is offset by “lower insurance premiums and lower medical care costs for all recipients of medical care.” This quid pro quo does not extend to the seriously injured medical malpractice victim and does not serve to bring the limited recovery provision within the rationale of the cases upholding the constitutionality of the Workmen’s Compensation Act.
Wright, 63 Ill.2d at 328, 347 N.E.2d at 742. Although Wright was not decided on “open *691courts” grounds, the Illinois Supreme Court expressly held that limiting recovery only in malpractice actions was “arbitrary,” which is at least part of our test under Sax.
It is significant to note that in two of the jurisdictions in which damages caps were upheld, the fact that alternative remedies were provided weighed heavily in the decisions. In Johnson v. St. Vincent Hospital, 404 N.E.2d at 601, the court stated “[t]he [Indiana] legislature responded by creating the patient compensation fund.” Louisiana enacted a statute with a patient compensation fund identical to the Indiana statute. Sibley v. Board ofSup’rs of Louisiana, 462 So.2d at 156, opinion modified, 477 So.2d 1094 (La.1985).
It should be remembered that the Medical Liability Act of 1977 (now article 4590i) was based on recommendations of the Texas Medical Professional Liability Study Commission, sometimes referred to as the Keeton Report. Dean Keeton, in a separate statement, recommended a victim’s compensation fund as a statutory substitute for limitations upon recovery. See Keeton Report at 51-52. The legislature chose not to follow this recommendation.
We also question whether the restrictions in sections 11.02 and 11.03 are reasonable when balanced against the purposes and bases of the statute.2 The legislature, in enacting article 4590i, apparently did not intend to strike at frivolous malpractice suits for it found in section 1.02(a)(2) that “the filing of legitimate health care liability claims in Texas is a contributing factor affecting medical professional liability rates” (emphasis added). The legislature did find that a “medical malpractice insurance crisis” had been created and that “satisfactory insurance coverage ... [was] often not available at any price,” but it then stated that “adoption of certain modifications in the medical, insurance, and legal systems ... may or may not have an effect on the rates charged by insurers for medical professional liability coverage.” Tex.Rev.Civ.Stat.Ann. art. 4590i, § 1.02(a)(5), (10), (12) (emphasis added).
In the context of persons catastrophically injured by medical negligence, we believe it is unreasonable and arbitrary to limit their recovery in a speculative experiment to determine whether liability insurance rates will decrease. Texas Constitution article I, section 13, guarantees meaningful access to the courts whether or not liability rates are high. As to the legislature’s stated purpose to “assure that awards are rationally related to actual damages,” section 1.02(b)(2), we simply note that this is a power properly attached to the judicial and not the legislative branch of government. Tex. Const, art. II, § 1. In any event, we hold it is unreasonable and arbitrary for the legislature to conclude that arbitrary damages caps, applicable to all claimants no matter how seriously injured, will help assure a rational relationship between actual damages and amounts awarded.
Even the Keeton Commission could not conclude there was any correlation between a damage cap and the stated legislative purpose of improved health care, stating that adequate data was lacking. Keeton Report at 7; id. at 38. One independent study has concluded that there is no relationship between a damage cap and increases in insurance rates [thereby reducing available health care], given that less than .6% of all claims brought are for over $100,000. Sumner, The Dollars and Sense of Hospital Malpractice Insurance, 9 (Aft Books 1979).
We are supported in our decision to strike down the damages caps in article 4590i by the reasoning of the Florida Supreme Court invalidating that state’s $450,-000 ceiling on noneconomic damages. Smith v. Department of Insurance, 507 So.2d 1080 (Fla.1987). Like the appellees in Smith, the medical defendant in our case argues that the legislature has not totally abolished a cause of action but merely placed a cap on damages that may be recovered and, therefore, has not denied the *692right of access to the courts. The Supreme Court of Florida rejected these arguments. After first pointing out that the constitutional right of access to the courts must be read in conjunction with the right of trial by jury, the court stated:
Access to the court is granted for the purpose of redressing injuries. A plaintiff who receives a jury verdict for, e.g., $1,000,000, has not received a constitutional redress of injuries if the legislature statutorily, and arbitrarily, caps the recovery. Nor, we add, because the jury verdict is being arbitrarily capped, is the plaintiff receiving the constitutional benefit of a jury trial as we have understood that right. Further, if the legislature may constitutionally cap recovery at $450,000, there is no discernible reason why it could not cap the recovery at some other figure, perhaps $50,000, or $1,000, or even $1.
Smith, 507 So.2d at 1088-89. Compare Boyd v. Búlala, 672 F.Supp. 915, 922 (W.D. Va.1987) ($1,000,000 damage cap violated right of jury trial under seventh amendment to the U.S. Constitution) (prior opinion in same case held that $750,000 cap violated right of jury trial under Virginia Constitution as well, 647 F.Supp. at 789).
The reasoning from the Smith opinion is entirely consistent with our “open courts” analysis in LeCroy v. Hanlon, 713 S.W.2d 335 (Tex.1986). LeCroy involved legislative interference with access to the courts by way of increased filing fees, much of which went to the state’s general revenue fund. Clearly this was not a total abolition of the right of access. Nevertheless, the court held the fee increases invalid under Tex. Const, art. I, § 13. 713 S.W.2d at 338-42. Our opinion in LeCroy also concisely explained the importance and uniqueness of state constitutional rights:
While state constitutions cannot subtract from rights guaranteed by the United States Constitution, state constitutions can and often do provide additional rights for their citizens. The federal constitution sets the floor for individual rights; state constitutions establish the ceiling. Recently, state courts have not hesitated to look to their own constitutions to protect individual rights. This court has been in the mainstream of that movement.
Like the citizens of other states, Texans have adopted state constitutions to restrict governmental power and guarantee individual rights. The powers restricted and the individual rights guaranteed in the present constitution reflect Texas’ values, customs, and traditions. Our constitution has independent vitality, and this court has the power and duty to protect the additional state guaranteed rights of all Texans. By enforcing our constitution, we provide Texans with their full individual rights and strengthen federalism.
LeCroy, 713 S.W.2d at 338-39 (citations and footnote omitted).
We understand the legislature’s concern in attempting to solve the health care problems it perceived during the middle of the 1970’s. Nevertheless, we agree with the statement by the Supreme Court of New Hampshire: “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).3
For the reasons stated in this opinion, our answer to the certified question is that the limitation on medical malpractice damages in Tex.Rev.Civ.Stat.Ann. art. 4590i, §§ 11.02 and 11.03, is inconsistent with and violative of article I, section 13, of the Texas Constitution. The additional question certified to us is moot.
*693GONZALEZ, J., files a dissenting opinion.
PHILLIPS, C.J., dissenting opinion to be filed.

. Although not necessary in light of our "open courts” holding, one wonders whether the drafters of the Texas Constitution intended for the legislature to enact special laws for the protection of specified classes of tortfeasors. Compare Tex. Const, art. I, § 3 ("[N]o man, or set of men, is entitled to exclusive ... privileges, but in consideration of public services.”) with Tex. Const, art. Ill, § 56 ("[I]n all other cases where a general law can be made applicable, no local or special law shall be enacted_”). A prior constitution left it to the legislature, "in its judgment,” to decide when a general law could be made applicable. Tex. Const, art. XII, § 40 (1873). This language does not appear in the present constitution. Tex. Const, art. Ill, § 56.

. In Sax v. Votteler, we said that the purpose and basis of a predecessor statute, Tex.Ins.Code Ann. art. 5.82, were legitimate. 648 S.W.2d at 667. However, that statute contained neither comparable legislative findings nor a limitation on damage recovery as in article 4590i.

. We note that in its efforts to protect health care providers from perceived harm, the legislature included other provisions in article 4590i that have failed to pass constitutional muster. See Neagle v. Nelson, 685 S.W.2d 11 (Tex.1985) (terminating a medical negligence cause of action before it was possible to be discovered violated the open courts provision); Sax v. Vot-teler, 648 S.W.2d 661 (Tex.1983) (depriving a minor of a medical negligence cause of action violated the open courts provision).