Court Opinion

ID: 9851250
Source: CourtListenerOpinion
Date Created: 2023-09-24 05:09:30.149759+00
Date Added: 2024-06-11T09:20:52.086864
License: Public Domain

White, C. Thomas, J.,
dissenting in part.
I agree with the majority opinion that the creation of the malpractice insurance authority by the Legislature does not constitute lending “the credit of the state” in violation of Article XIII, section 3, Constitution of Nebraska.
I agree that it was within the power of the Legislature to determine that a medical malpractice crisis exists although the record before us does not reflect the existence of such a crisis. If there has been an explosion in malpractice claims, the resulting inundation has not reached this court.
The five such cases this court has heard in the last two years comprise less than 1 percent of the docket of this court. I further note the recent reduction in medical malpractice rates by the Director of Insurance as stipulated in the record by the parties.
Were it within the province of this court to determine whether a sufficient emergency exists to warrant the separate and differing treatment of medical malpractice from the remainder of the body of tort law, I would unhesitatingly suggest that no such evidence has yet been presented us. However, as the majority opinion suggests, this is a matter for the Legislature, and the Legislature has spoken.
The majority opinion characterizes the action as a “declaratory judgment action seeking a determination of the constitutionality of the Nebraska Hospital-Medical Liability Act, sections 44-2801 to 44-2855, R. S. Supp., 1976.” The majority opinion of this court then affirms the judgment of the trial court that the act is constitutional. We do so, in many instances, as Judge Clinton’s dissent points out, without the presence of any person whose rights might be adversely affected by sections of the act.
*128It has been the long-established principle that this court will not pass upon the constitutionality of a statute except at the suit of a person whose rights are adversely affected by the provisions of the statutes which are challenged as unconstitutional. State ex rel. Douglas v. Gradwohl, 194 Neb. 745, 235 N. W. 2d 854; Blackledge v. Richards, 194 Neb. 188, 231 N. W. 2d 319; State v. Brown, 191 Neb. 61, 213 N. W. 2d 712; Ritums v. Howell, 190 Neb. 503, 209 N. W. 2d 160; Metropolitan Utilities Dist. v. Merritt Beach Co., 179 Neb. 783, 140 N. W. 2d 626; Bali Hai’, Inc. v. Nebraska Liquor Control Commission, 195 Neb. 1, 236 N. W. 2d 614; Stanton v. Mattson, 175 Neb. 767, 123 N. W. 2d 844. A declaratory judgment action does not alter this basic standing requirement. Proceedings for a declaratory judgment extend to the validity of a statute when there is a justiciable, determinable controversy between parties in respect to rights thereof. Nebraska Mid-State Reclamation Dist. v. Hall County, 152 Neb. 410, 41 N. W. 2d 397 (1950).
Adherence to the above principle would have limited the majority opinion to the only issue properly raised before it — whether the act provides for an unconstitutional grant of state credit. Despite the lack of concrete adversity between the parties on any further constitutional issues raised, the majority opinion decided to “make an exception in this instance and review all the questions of constitutionality raised in the answer” of the defendant Director of Insurance.
The majority opinion statement that the act is constitutional should not be interpreted as a determination that all sections of the act are constitutional. Only those challenges discussed in the majority opinion have been briefed and argued in this court. The consideration of a cause on appeal is limited to those errors which have been assigned and argued. Schetzer v. Sullivan, 193 Neb. 841, 229 N. W. 2d 550 *129(1975); McClellen v. Dobberstein, 189 Neb. 669, 204 N. W. 2d 559 (1973). The defendant has not challenged numerous sections of the act. The majority opinion should be limited to only those issues which have been assigned and argued.
The majority opinion concludes that the necessity of insuring adequate health care as perceived by the Legislature justifies the completely different treatment of medical-hospital tort claims as against the entire tort liability field. The genuinity of the “malpractice insurance” crisis is the subject of lively debate, as are the rates charged by carriers in this state to health care providers vis-a-vis, the announced totals paid to claimants in this state.
As I have previously conceded, it is within the power of the Legislature to determine the existence of a medical malpractice crisis and act thereon. This power to act is not without limitation. The action must be reasonable. The test is, as the majority opinion points out, that of the reasonable relationship of the means utilized to the purpose to be achieved. Assuming, however, as does the majority opinion, that the Legislature may appropriately limit and alter the common law right of action of claimants, it is difficult to justify the reasonable relation of the area of justified concern of the Legislature to some of the means employed.
Two provisions of the act, restricting the potential liability of health care providers in malpractice cases, are clearly unconstitutional as special legislation. Section 44-2819, R. S. Supp., 1976, provides that any payment to a claimant from a nonrefundable medical reimbursement insurance plan, by reason of his alleged injury, may be taken as a credit against any judgment rendered under the act. This is a significant deviation from the total concept of restitution in that a negligent party may escape paying for a portion of the damage he causes. Section 44-2825, R. S. Supp., 1976, limits the total amount re*130coverable under the act from a health care provider to $500,000. Likewise, section 44-2825, R. S. Supp., 1976, provides for a shifting of the burden from the responsible health provider tort-feasor, but, here, the burden is shifted not to a collateral source, but to the malpractice victim himself.
If, as the majority opinion suggests, the collateral source rule enriches claimants in health care cases, why does it not do so in every other tort case? The tort-feasor operating a motor vehicle is not entitled to receive credit from the personal resources or prudence of his victim. Nor, under the same analysis, is there justification for limiting the maximum amount recoverable as judgment, since other tortfeasors do not enjoy such limited liability.
Such provisions violate Article III, section 18, of the Nebraska Constitution, which 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; * * * where a general law can be made applicable, no special law shall be enacted.”
The Idaho Supreme Court was faced with the same issue of recovery limitation as special legislation in Jones v. State Board of Medicine, 97 Idaho 859, 555 P. 2d 399 (1976). There the ceiling was $150,000 per claim. The court, while not passing on the equal protection challenge to the limitation, did hold that it was not special legislation under the Idaho Constitution. However, the basis of the court’s holding is the provision in the Idaho Constitution which prohibits special laws only in regard to matters specifically mentioned therein. The Jones opinion contrasted this provision to the California Constitution which has a “catch-all restriction against special laws where a general law would apply.” The court there suggests a different holding *131on an issue of liability limitation as special legislation may be in order under a constitutional provision such as California’s.
The majority opinion discusses the Illinois Supreme Court’s decision in Wright v. Central Du Page Hospital Assn., 63 111. 2d 313, 347 N. E. 2d 736 (1976), in relation to the constitutionality of medical review panels. In Wright, the Illinois court also held that limitation of recovery in malpractice actions constituted special legislation in violation of the Illinois Constitution, as well as being a denial of equal protection under the federal and Illinois Constitutions. Like the Nebraska statute in issue, the Illinois statute provided a $500,000 ceiling on recovery.
The Illinois court summarized the arguments against the limitation: “Plaintiff argues that by denying recovery for loss and damage in excess of $500,000, the General Assembly has arbitrarily classified, and unreasonably discriminated against, the most seriously injured victims of medical malpractice, but has not limited the recovery of those victims who suffer moderate or minor injuries. She points out that the burden of this legislative effort to reduce or maintain the level of malpractice insurance premiums falls exclusively on those extremely unfortunate victims who most need financial protection.” The Illinois court concluded: “We are of the opinion that limiting recovery only in medical malpractice actions to $500,000 is arbitrary and constitutes a special law in violation of section 13 of Article IV of the 1970 Constitution, and we so hold.” Wright v. Central Du Page Hospital Assn., supra.
Article IV, section 13, of the Illinois Constitution provides: “The General Assembly shall pass no special or local law when a general law is or can be made applicable * * *.”
The section is strikingly similar to Article III, section 18, of the Nebraska Constituion, which states “where a general law can be made applicable no *132special law shall be enacted.” The majority opinion’s partial reliance on the elective provisions of the act is misplaced. The reality of the freedom to elect by a claimant was not considered and is not easily demonstrable. Such an election provision ignores the inequality of bargaining power. The very nature of a person’s status as a patient places him in a position which makes effective bargaining difficult. A right to elect not to be covered, from which might result a denial of service from the only hospital or physician in a geographical area, can hardly be said to be without implicit coercion. The consideration that the election may result in termination of services, or refusal by health care providers to give service, because of knowledge that the patient has previously filed a notice with the state Department of Insurance not to be covered, will cause a thoughtful person to use caution in exercising the right.
In summary, I agree with the majority opinion that the Nebraska Hospital-Medical Liability Act does not provide an unconstitutional grant of state credit. This was the only issue the parties had standing to raise and the only issue this court should have decided. The majority opinion’s holding of constitutionality of the act is limited only to those issues discussed therein. Sections 44-2819 and 44-2825, R. S. Supp., 1976, limiting a tort-feasor’s liability under the act, are unconstitutional as special legislation prohibited by Article III, section 18, of the Nebraska Constitution. These constitutionally defective provisions are not cured by the election process provided by the act.
Clinton, J., joining partially in the dissent of White, C. Thomas, J.
I join in the dissent of White, C. Thomas, J., with the following exception. For the reasons stated in the part of my opinion dissenting from the majority, I do not consider it appropriate to express an opinion as to the unconstitutionality of an act where no party *133whose rights are affected thereby is a party to the proceeding, any more than I consider it appropriate to hold that some portion of the act is constitutional where there is no party before this court affected by the provision in question. Therefore I do not join in the portion of the dissent of White, C. Thomas, J., which expresses an opinion as to unconstitutionality.
I particularly join in the portion of the dissent which notes that while the majority opinion appears to give blanket approval to the constitutionality of the act, it should not be considered as deciding the constitutionality of the portions of the act the constitutionality of which is not even argued.