Court Opinion

ID: 9640751
Source: CourtListenerOpinion
Date Created: 2023-08-22 17:14:30.535766+00
Date Added: 2024-06-11T18:10:32.618162
License: Public Domain

GONZALEZ, Justice,
dissenting.
I dissent. The issue is not the wisdom or fairness of the cap, but whether the cap bears a reasonable relation to a proper legislative purpose. I would hold that the limitation on recovery of nonmedical damages does not violate either the Equal Protection or the Due Process guarantees which are set forth in the Texas Constitution.

History and Legislative Findings

In 1975, the Texas Legislature enacted legislation creating the Texas Medical Professional Liability Study Commission. The function of the Commission was to study the reasons why physicians, hospitals, and other health care providers were experiencing tremendous increases in malpractice insurance premiums. The Commission held hearings, gathered evidence and submitted recommendations to the legislature that reconvened in 1977. The legislature considered a majority and several minority reports before it enacted The Medical Liability and Insurance Improvement Act, found in TEX.REY.CIV.STAT.ANN. art. 4590i (Vernon Supp.1988). See Keith, The Texas Medical Liability and Insurance Improvement Act — A Survey and Analysis of its History, Construction and Constitutionality, 36 Baylor L.Rev. 265 (1984).
The Act provides: The Legislature of the State of Texas finds that:
(1) the number of health care liability claims (frequency) has increased since 1972 inordinately;
(2) the filing of legitimate health care liability claims in Texas is a contributing factor affecting medical professional liability rates;
(3) the amounts being paid out by insurers in judgments and settlements (severity) have likewise increased inordinately in the same short period of time;
(4) the effect of the above has caused a serious public problem in availability of and affordability of adequate medical professional liability insurance;
(5) the situation has created a medical malpractice insurance crisis in the State of Texas;
(6) this crisis has had a material adverse effect on the delivery of medical and health care in Texas, including significant reductions of availability of medical and health care services to the people of Texas and a likelihood of further reductions in the future;
(7) the crisis has had a substantial impact on the physicians and hospitals of Texas and the cost to physicians and hospitals for adequate medical malpractice insurance has dramatically risen in price, with cost impact on patients and the public;
(8) the direct cost of medical care to the patient and public of Texas has materially increased due to rising cost of malpractice insurance protection for physicians and hospitals in Texas;
(9) the crisis has increased the cost of medical care both directly through fees and indirectly through additional services provided for protection against future suits or claims; and defensive medicine has resulted in increasing cost to patients, private insurers, and the state and has contributed to the general inflation that has marked health care in recent years;
(10) satisfactory insurance coverage for adequate amounts of insurance in this area is often not available at any price;
(11) the combined effect of the defects in the medical, insurance, and legal systems has caused a serious public problem both with respect to the availability of coverage and to the high rates being charged by insurers for medical professional liability insurance to some physicians, health care providers, and hospitals;
(12) the adoption of certain modifications in the medical, insurance, and legal systems, the total effect of which is currently undetermined, may or may not have an effect on the rates charged by *694insurers for medical professional liability insurance;
(13) these facts have been verified by the Medical Professional Liability Study Commission, which was created by the 64th Legislature. For further amplification of these facts the legislature adopts the findings of the report of the commission.
TEX.REV.CIV.STAT.ANN. art. 4590Í, § 1.02(a) (Vernon Supp.1988) (emphasis added).
The stated purposes of the Act are to:
(1) reduce excessive frequency and severity of health care liability claims through reasonable improvements and modifications in the Texas insurance, tort, and medical practice systems;
(2) decrease the cost of those claims and assure that awards are rationally related to actual damages;
(3) do so in a manner that will not unduly restrict a claimant’s rights any more than necessary to deal with the crisis;
(4) make available to physicians, hospitals, and other health care providers protection against potential liability through the insurance mechanism at reasonably affordable rates;
(5) make affordable medical and health care more accessible and available to the citizens of Texas;
(6) make certain modifications in the medical, insurance, and legal systems in order to determine whether or not there will be an effect on rates charged by insurers for medical professional liability insurance; and
(7) make certain modifications to the liability laws as they relate to health care liability claims only and with an intention of the legislature to not extend or apply such modifications of liability laws to any other area of the Texas legal system or tort law.
TEX.REV.CIV.STAT.ANN. art. 4590i, § 1.02(b) (Vernon Supp.1988).1
As a starting point in our constitutional review of article 4590i, it cannot be overemphasized that:
[W]e begin with a presumption of validity. It is to be presumed that the Legislature has not acted unreasonably or arbitrarily; and a mere difference of opinion, where reasonable minds could differ, is not a sufficient basis for striking down legislation as arbitrary or unreasonable. The wisdom or expediency of the law is the Legislature’s prerogative, not ours.... There is a strong presumption that a Legislature understands and correctly appreciates the needs of its own people, that its laws are directed to problems made manifest by experience, and that its discriminations are based upon adequate grounds.
Smith v. Davis, 426 S.W.2d 827, 831 (Tex.1968); see also Sax v. Votteler, 648 S.W.2d 661, 664 (Tex.1983). This presumption of constitutionality applies “whether the basis of constitutional attack is grounded in due process or equal protection.” Whitworth v. Bynum, 699 S.W.2d 194, 197 (Tex.1985). The burden of demonstrating constitutional invalidity rests on the party assailing the statute. Robinson v. Hill, 507 S.W.2d 521, 524 (Tex.1974); Smith v. Craddick, 471 S.W.2d 375, 378 (Tex.1971).

Equal Rights

The Fourteenth Amendment to the United States Constitution provides that “[n]o State shall ... deny to any person within its jurisdiction the equal protection of the laws.” U.S. CONST, amend. XIV, § 1. Similarly, the Texas Constitution states that “[a]ll free men, when they form a social compact, have equal rights....” TEX. CONST, art. I, § 3.
Under traditional equal protection analysis, different levels of judicial scrutiny are applied depending upon the type of individual right which the State has chosen to affect through legislative classification. Under the equal protection clause of the *695Fourteenth Amendment, this Court has previously applied a two-tier analysis:
[T]he general rule is that when the classification created by the state regulatory scheme neither infringes fundamental rights or interests nor burdens an inherently suspect class, equal protection analysis requires that the classification be rationally related to a legitimate state interest.
Sullivan v. University Interscholastic League, 616 S.W.2d 170, 172 (Tex.1981). Thus, if the legislative classification does not affect a fundamental right or a suspect class, it need only be rationally related to a legitimate state interest in order to pass constitutional muster. See Vance v. Bradley, 440 U.S. 93, 97, 99 S.Ct. 939, 942-43, 59 L.Ed.2d 171 (1979). We apply this same two-prong analysis to the equal protection clause contained in Article I, Section 3 of the Texas Constitution. Spring Branch I.S.D. v. Stamos, 695 S.W.2d 556, 559-60 (Tex.1985).
The right accorded to a plaintiff to sue in tort for an injury is not a fundamental right. See Sibley v. Board of Sup’rs of Louisiana, 462 So.2d 149, 155, opinion modified, 477 So.2d 1094 (La.1985). Accordingly, the appropriate level of scrutiny to be applied in this case is whether the classifications drawn by article 4590i are rationally related to a legitimate state interest. See Whitworth, 699 S.W.2d at 197; Spring Branch, 695 S.W.2d at 559.
Article 4590i creates two classifications. First, section 11.02 draws a distinction between medical malpractice claimants and other tort claimants. Second, within the class of medical malpractice claimants, there is a distinction drawn based upon whether damages exceed $500,000. Under the rational basis test, I cannot say that this statute is not rationally related to the stated purposes of section 1.02(b). “Whether in fact the Act will [achieve its stated goals] is not the question: the Equal Protection Clause is satisfied ... if the Legislature could rationally have decided” that a cap of nonmedical damages would effectuate those goals. See Minnesota v. Clover Leaf Creamery Co., 449 U.S. 456, 466,101 S.Ct. 715, 725, 66 L.Ed.2d 659 (1980) (emphasis in original).
Where a local economic regulation is challenged on equal protection grounds, we must defer “to legislative determinations as to the desirability of particular statutory discrimination.” New Orleans v. Dukes, 427 U.S. 297, 303, 96 S.Ct. 2513, 2517, 49 L.Ed.2d 511 (1975).
In short, the judiciary may not sit as a super-legislature to judge the wisdom or desirability of legislative policy determinations made in areas that neither affect fundamental rights nor proceed along suspect lines ..., in the local economic sphere, it is only the invidious discrimination, the wholly arbitrary act, which cannot stand consistently with the Fourteenth Amendment.
Id. at 303-04, 96 S.Ct. at 2517 (citations omitted). This reasoning applies with equal force to the equal rights provision of Article I, Section 3 of the Texas Constitution.

Due Course

Article I, Section 19 of the Texas Constitution provides:
No citizen of this state shall be deprived of life, liberty, property, privileges or immunities, or in any manner disfranchised, except by the due course of the law of the land.
TEX. CONST, art. I, § 19.
Article I, Section 19 and the Fourteenth Amendment to the United States Constitution impose similar restrictions on the legislature. TEX. CONST, art. I, § 19; Lively v. Missouri K. & T. Ry. Co. of Texas, 102 Tex. 545,120 S.W. 852 (1909); Mellinger v. City of Houston, 3 S.W. 249 (Tex.1887); Massachusetts Indem. & Life v. Tex. State Bd. of Ins., 685 S.W.2d 104 (Tex.App.— Austin 1985, no writ). The standard of review for constitutional challenges on substantive due process grounds for both the state and federal due process clauses is as follows:
If the laws passed are seen to have a reasonable relation to a proper legislative purpose, and are neither arbitrary nor *696discriminatory, the requirements of due process are satisfied....
Nebbia v. New York, 291 U.S. 502, 537, 54 S.Ct. 505, 516, 78 L.Ed. 940 (1933).
Accordingly, I would apply the following standard of review under Article I, Section 19 of the Texas Constitution: whether the medical caps in article 4590i bear a reasonable relation to a proper legislative purpose. Under this standard, I cannot say that the limitation of damages provisions violate Article I, Section 19 of our state constitution.

Open Courts

The other due process guarantee in the Texas Constitution is the open courts provision, which provides as follows:
All courts shall be open, and every person for an injury done him, in his lands, goods, person or reputation, shall have remedy by due course of law.
TEX. CONST., art. I, § 13. Similar guarantees are found in the constitutions of thirty-seven other states. 1 G. Braden, The Constitution of the State of Texas: An Annotated and Comparative Analysis 51 (1977).
Article I, Section 13 provides two separate and distinct guarantees: (1) all courts shall be open, and (2) every person shall have remedy for injury by due course of law. The former category guarantees a right of “access,” while the latter category guarantees a right of “redress.” No opinion of this court has discussed the independent guarantee of redress; rather, the focus of our analysis has been upon those legislative enactments which impose impossible or unreasonable conditions on a litigant’s right of access to the courts. It is of course obvious that an entire abrogation of access results in an entire denial of redress. Thus, to that extent, the right of access and redress are inextricably intertwined. However, this case presents a slightly different question because section 11.02 of Article 4590i leaves the right of access wholly intact; only the right of redress is partially restricted.
Thus, this case presents two important questions of first impression. Does a legislative enactment which partially restricts the right of redress trigger the protections of Article I, Section 13? If so, what is the appropriate standard of review to be applied?
I have found no case which interprets the open courts provision as independently protecting a litigant's right of redress. I am mindful, however, of the text of our Constitutional provision: “every person ... shall have remedy by due course of law.” TEX. CONST, art. 1, § 13. I agree with the majority that the protections of Article I, Section 13 do extend to legislative enactments which allow free access but restrict redress. I further agree that the appropriate standard of review is whether the legislative purpose for the statute outweighs the partial diminution of a litigant’s constitutionally-guaranteed right of redress. I vigorously disagree, however, with the majority’s implication that the appropriate standard of review includes the existence of a reasonable substitute (individual quid pro quo) as a constitutional prerequisite to statutory validity.

Standard of Review

It is at this juncture that I depart from the majority opinion, and register my dissent. The challenged statute here restricts but does not totally abrogate recovery.2 I would hold that section 11.02 of article 4590i is constitutional under Article I, Section 13.
This court recently articulated the standard for reviewing the constitutionality of a statute which abrogates the individual’s *697right of access. In Sax v. Votteler, 648 S.W.2d 661 (Tex.1983) we noted:
[T]he right to bring a well established common law cause of action cannot be effectively abrogated by the legislature absent a showing that the legislative basis for the statute outweighs the denial of the constitutionally-guaranteed right of redress. In applying this test, we consider both the general purpose of the statute and the extent to which the litigant’s right of redress is affected....
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.
Id. at 666.3
While we have referred to the nonexistence of a reasonable substitute in cases holding certain legislative enactments unconstitutional, this court has fallen short of requiring the existence of an individual quid pro quo in order to survive constitutional attack. Id. at 667 (citing Middleton v. Texas Power & Light Co., 185 S.W. 556 (1916), affd 249 U.S. 152, 39 S.Ct. 227, 63 L.Ed. 527 (1919)). It must be noted that the court in Middleton viewed the open courts provision as merely proscribing legislative abolition of intentional wrongs. Middleton, 185 S.W. at 560; Reed Tool Co. v. Copelin, 610 S.W.2d 736, 739 (Tex.1980). Not only could the legislature modify or abolish the common law rule of contributory negligence, it could entirely abolish negligence altogether:
If, in a word, [the Legislature] may declare that contributory negligence shall no longer be a defense, may it not also declare, as to purely accidental injuries, that negligence shall no longer be actionable? If is may also change defensive common law rules, may it not also change a common law rule of liability? The power of the Legislature cannot exist in the one instance and not in the other.
Id. at 561. How then could Middleton be authority that a reasonable substitute remedy is constitutionally required when that decision did not even interpret legislative modifications of non-intentional acts as triggering the protections of Article I, Section 13? It simply cannot.
While the majority is guarded in its language, the implied basis in today’s opinion for striking down the damages limitations is a perceived lack of a reasonable substitute for the impairment of the litigant’s right of redress. I believe that this requirement can be harmonized with our test set out in Sax by making the existence of an individual quid pro quo a factor in determining whether the statutory scheme denying the constitutionally-guaranteed right of redress is reasonable.
It must be emphasized that the language in Sax, which refers to the substitution of other remedies, is borrowed from Lebohm v. City of Galveston, 275 S.W.2d 951, 954 (1955). Yet Lebohm did not limit its holding to the substitution of an individual remedy. Rather, the court expressly recognized that an individual quid pro quo is unnecessary if a societal quid pro quo exists:
Thus it may be seen that legislative action withdrawing common-law remedies for well-established common-law causes of action for injuries to one’s “lands, goods, person or reputation” is sustained only when it is reasonable in substituting other remedies, or when it is a reasonable exercise of the police power in the interest of the general welfare.
Id. at 955 (emphasis added).
This court has never expressly required an individual quid pro quo in the past; to do so now would unquestionably restrain the legislature’s ability and duty to effect social change through legislative enactment. Article I, Section 13 does not guarantee the continued existence of a common *698law cause of action, but only proscribes the creation of an impossible or unreasonable impediment to access or redress to vindicate a recognized and justiciable substantive right. The open courts provision was never intended to create any new rights, nor was it intended to elevate the common law to constitutional stature.

Sax and Article 4590i, Section 11.02

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 Le-bohm). 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;
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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:
[Ejven 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 Consum*699er 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.

Out of State Authorities

The majority concludes that a $500,000 cap on nonmedical damages is arbitrary, and cites with approval Wright v. Central Du Page Hospital Ass’n, 63 I11.2d 313, 347 N.E.2d 736, 742 (1976). Reliance on Wright is inappropriate and misplaced. In Wright, the defendant, relying upon case law upholding constitutional challenges to the Illinois Workman’s Compensation Act, maintained there existed under that state’s damages cap a societal quid pro quo: the loss of recovery potential to some plaintiffs was offset by the lower medical care and insurance costs to society in general. The Illinois Supreme Court rejected this argument because any quid pro quo that existed was insufficient to save the challenged statutory provision. Id., 347 N.E.2d at 742. The crucial distinction in Wright, however, was the court’s concern that under the Illinois statute, medical expenses were capped. Unlike the Workman’s Compensation Act, which allowed all “medical expenses and payment of compensation for the duration of ... incapacity,” the medical malpractice plaintiff may “be unable to recover even all the medical expenses he might incur.” Id. Such is not the case in Texas. Article 4590i allows full and complete recovery of all medical expenses; only nonmedical damages are capped. TEX.REV.CIV.STAT.ANN. art. 4590i, § 11.02 (Vernon Supp.1988).
The majority places great emphasis on the fact that in some of the jurisdictions which upheld statutes imposing damages caps, alternative remedies were provided. See 757 S.W.2d 689 (citing Johnson v. St. Vincent Hospital, 273 Ind. 374, 404 N.E.2d 585, 601 (1980); Sibley v. Board of Sup’rs of Louisiana, 462 So.2d 149, 156, opinion modified, 477 So.2d 1094 (La.1985)). It should be noted, however, that both Indiana and Louisiana have medical caps of $500,000 as an absolute ceiling on all damages, thus necessitating in my view a higher level of constitutional justification. See generally, Johnson, 404 N.E.2d at 601 (existence of patient compensation fund to increase availability of medical insurance); see also Sibley, 462 So.2d at 156 (Louisiana’s Act modeled on Indiana’s Act). Neither court required the existence of a quid pro quo as a constitutional prerequisite.
The majority’s reliance on Smith v. Department of Insurance, 507 So.2d 1080 (Fla.1987), is equally unconvincing. Although Smith held that a $450,000 cap on noneconomic damages violated Florida’s open courts provision, it did so because no “legislative showing of an overpowering public necessity for the abolishment of such right, and no alternative method of meeting such public necessity can be shown.” Id. at 1089. Such a heightened standard is not followed in Texas. As stated previously, the test to be applied in the context of a constitutional challenge under Texas’ open courts provision is whether the diminution of redress is “unreasonable or arbitrary when balanced against the purpose and basis of the statute.” Sax, 648 S.W.2d at 666. I cannot conclude that section 11.02 is constitutionally infirm under the standard enunciated in Sax.
Reliance on Ameson v. Olson, 270 N.W.2d 125 (N.D.1978) is also misplaced. North Dakota’s damages cap was a total cap of $300,000 which might prevent seriously injured victims from recovering all of their medical expenses. As previously noted, such is not the case in Texas.
It is true that several states have invalidated statutory provisions limiting damages in medical malpractice actions on a *700variety of theories. With only two exceptions, however, these invalidated statutes contained absolute ceilings on both pecuniary and nonpecuniary damages.4 What distinguishes article 4590i from other statutory schemes is its full allowance of all medical costs and expenses; only nonmedical injuries are limited.
The majority cites with approval the language used by the Supreme Court of Florida: “[I]f the legislature may constitutionally cap recovery at $450,000 there is no discernable reason why they could not cap the recovery at some other figure, perhaps $50,000 or $1,000 or $1.” At 692. This argument ignores the fact that any modification the legislature makes is subject to being stricken as unconstitutional. A reduction of nonmedical damages to a lesser cap at some point would be manifestly so insufficient as to become a denial of justice.
Plaintiffs have no vested property rights in a particular measure of damages. This is without doubt since a “vested right” must be something more than a mere expectation based on anticipated continuance of existing law. It must become a title, legal or equitable, to present or future enjoyment of property. National Carloading Corp. v. Phoenix-El Paso Express, 142 Tex. 141, 176 S.W.2d 564 (1944), cert, denied, 322 U.S. 747, 64 S.Ct. 1156, 88 L.Ed. 1578 (1944). The legislature has broad powers to modify the scope and nature of such damages. See American Bank & Trust Co. v. Community Hospital, 36 Cal.3d 359, 204 Cal.Rptr. 671, 683 P.2d 670 (1984). I am not prepared to hold that an award of close to $1 million ($500,-000 plus consumer index adjustment provided for in § 11.04 of the Act) for nonmedical damages coupled with no limitation on past and future medical expenses is so arbitrary and unreasonable that it does not pass constitutional muster. Therefore, this cap is no more a violation of the open courts provision of the Texas Constitution than the fee increase was in LeCroy, 713 S.W.2d at 343 (Gonzalez, J., dissenting).

Special Legislation

The majority intimates that the damages caps of article 4590i constitute a special law in violation of Article III, section 56 of the Texas Constitution. That section prohibits the Legislature from passing local or special laws, except as otherwise provided by the Texas Constitution. TEX. CONST, art. Ill, § 56. In Clark v. Finley, 93 Tex. 171, 54 S.W. 343 (1899), the court defined a “local” law as one which confines its operation to a fixed part of the territory of the state. Id. at 346. A “special law” was defined as a statute which relates to particular persons or things of a class. Id. at 345.
The damages caps cannot be classified as a local law because these statutes apply equally to all citizens throughout the State of Texas. Wood v. Wood, 159 Tex. 350, 320 S.W.2d 807, 809 (1959); County of Cameron v. Wilson; 160 Tex. 25, 326 S.W. 2d 162, 165 (1959); Clark v. Finley, 54 S.W. 343, 346. Nor can it be said that section 11.02 of article 4590i constitutes a special law in favor of a certain class of litigants. As we said in Miller v. El Paso County, 136 Tex. 370, 150 S.W.2d 1000, 1001-1002 (1941):
[T]he courts recognize in the Legislature a rather broad power to make classifications for legislative purposes and to enact laws for the regulation thereof, even though such legislation may be applicable only to a particular class....; such legislation must be intended to apply uniformly to all who may come within the classification designated in the Act, and the classification must be broad enough to include a substantial class and must be based on characteristics legitimately distinguishing such class from others with respect to the public purpose sought to be accomplished....
Thus, the Legislature is unquestionably empowered to create classifications of per*701sons and things, so long as the classifications are not arbitrary. Where a reasonable relationship exists between the classification and the objectives sought to be accomplished by the statute, Article III, Section 56 is not violated. Id. See also Smith v. Davis, 426 S.W.2d 827, 830 (Tex.1968).
It is evident that the class affected by the medical damages caps are health care providers. Distinguishing that class of tortfeasors from others is reasonable in light of the legislative findings that a medical malpractice insurance crisis exists in Texas, and the legislative objectives of increasing the availability and affordability of health insurance in this state. The primary and ultimate test for determining whether the caps pass constitutional scrutiny under Article III, Section 56 has been met: there is a reasonable basis for the classification it makes, and the law operates equally on all within the class. Robinson v. Hill, 507 S.W.2d 521, 525 (Tex.1974).

Conclusion

At the time 4590i was enacted, Texas was faced with a crisis in the affordability and availability of medical malpractice insurance. As a result of the crisis, many physicians and health care providers had ceased or reduced the scope of their practice. We must measure whether the legislature’s action was arbitrary in light of these circumstances. Even though many of the findings made by the legislature were not based upon Texas’ experience, the legislature could have reasonably believed that without some measure of cost reduction, future medical malpractice claimants would experience difficulty in obtaining collectible judgments for any of their damages. Thus, the legislature could have reasonably and rationally concluded that capping the amount of nonmedical damages in a medical malpractice action would improve the availability and cost of malpractice insurance in the State of Texas.
I acknowledge that there are serious questions surrounding the causes of the medical malpractice insurance crisis. I also acknowledge that the validity of some of the findings made by the Study Commission and adopted by the legislature are questionable. However, the findings are “legislative facts” which should be accorded great deference by this court, particularly because reasonable minds can differ as to the causes of the crisis. For us to “unfind” that there is a crisis on the state of this record is to act like a “super legislature” in violation of the separation of powers doctrine. We must respect the process. Whatever flaws exist in the legislative findings, the proper forum to correct them is the Texas Legislature and not this court. For the above reasons, I dissent.
MAY 25, 1988

. What deference or status should our court give these findings? Should we just ignore them as the majority has done?

. As will be discussed, neither Middleton, Le-bohm, Sax, nor this case requires an individual quid pro quo. However, even if a cogent argument can be made that these authorities do in fact require an individual substitute, none of these cases deal with legislation which partially restrict redress. To the contrary, these decisions construe enactments which totally abrogate a well-defined common law cause of action. Because this case presents a much less intrusive level of interference, I submit the corresponding standard of review does not require the existence of an individual quid pro quo; a societal quid pro quo is sufficient. Lebohm, 275 S.W.2d at 955.

. Although Sax refers to the right of redress, it is undisputed that the child’s right to bring a well established common law cause of action was completely abrogated. Id. at 667. Thus, Sax is an "access” case rather than a "redress” case.

. The two exceptions are New Hampshire and Florida. See Carson v. Maurer, 424 A.2d 825, 836 (1980); Smith v. Department of Insurance, 507 So.2d 1080, 1088-89 (Fla.1987). Both courts struck down the medical caps according to a heightened "intermediate scrutiny” standard of review. Texas does not apply such a standard.