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North Broward Hospital District v. Kalitan

Supreme Court of Florida

June 8, 2017

NORTH BROWARD HOSPITAL DISTRICT, etc., et al., Appellants,
v.
SUSAN KALITAN, Appellee.

         NOT FINAL UNTIL TIME EXPIRES TO FILE REHEARING MOTION, AND IF FILED, DETERMINED.

         An Appeal from the District Court of Appeal - Statutory or Constitutional Invalidity Fourth District - Case Nos. 4D11-4833, 4D11-4834, & 4D11-4806 (Broward County)

          Mark Hicks and Dinah Stein of Hicks, Porter, Ebenfeld & Stein, P.A., Miami, Florida, for Appellants North Broward Hospital District d/b/a Broward General Medical Center, Rob Alexander, M.D., Edward Punzalan, CRNA and ANESCO North Broward, LLC

          Thomas A. Valdez and Jeffrey R. Creasman of Quintairos, Prieto, Wood & Boyer, P.A., Tampa, Florida, for Appellants Barry University, Inc., and Eleidy Miedes, SRNA

          Crane A. Johnstone and Scott P. Schlesinger of Schlesinger Law Offices, P.A., Fort Lauderdale, Florida; and Philip M. Burlington and Nichole J. Segal of Burlington & Rockenbach, P.A., West Palm Beach, Florida, for Appellee

          Pamela Jo Bondi, Attorney General, and Osvaldo Vazquez, Deputy Solicitor General, Tallahassee, Florida, for Amicus Curiae State of Florida

          Mark K. Delegal and Tiffany A. Roddenberry of Holland & Knight LLP, Tallahassee, Florida; and William W. Large of Florida Justice Reform Institute, Tallahassee, Florida, for Amici Curiae Florida Justice Reform Institute and Florida Hospital Association, Inc.

          Tracy Raffles Gunn of Gunn Appellate Practice, P.A., Tampa, Florida, for Amicus Curiae Florida Justice Association

          PER CURIAM.

         This case is before the Court on appeal from a decision of the Fourth District Court of Appeal, North Broward Hospital District v. Kalitan, 174 So.3d 403 (Fla. 4th DCA 2015), which held section 766.118, Florida Statutes (2011), to be invalid. We have jurisdiction. See art. V, § 3(b)(1), Fla. Const. For the following reasons, we affirm the Fourth District's decision and hold that the caps on personal injury noneconomic damages in medical negligence actions provided in section 766.118 violate the Equal Protection Clause of the Florida Constitution.[1]

         FACTS AND PROCEDURAL HISTORY

         This case arose after complications from carpal tunnel surgery left appellee Susan Kalitan severely injured. After trial, Kalitan's noneconomic damages were capped by sections 766.118(2) and (3). Section 766.118(2) provides that in a cause of action for personal injury arising from the medical negligence of practitioners, the noneconomic damages award shall not exceed $500, 000 per claimant; however, if the negligence resulted in a permanent vegetative state or death, or if the negligence caused a catastrophic injury and a manifest injustice would occur unless increased damages are awarded, then damages may be awarded in an amount up to $1 million. Section 766.118(3) similarly limits damages to $750, 000 and $1.5 million, respectively, when the injury results from the negligence of nonpractitioners. The Fourth District held that the statutory caps on noneconomic damage awards in personal injury medical malpractice actions are unconstitutional, relying on this Court's decision in Estate of McCall v. United States, 134 So.3d 894 (Fla. 2014), which held that the cap on wrongful death noneconomic damages provided in section 766.118 violates the Equal Protection Clause of the Florida Constitution. Art. I, § 2, Fla. Const.

         The Fourth District presented the following facts of Kalitan's injury and the ensuing medical malpractice lawsuit:

         I. Background

In 2007, Plaintiff went to defendant North Broward Hospital District ("the Hospital") for outpatient surgery to treat carpal tunnel syndrome in her wrist. The surgery required Plaintiff to be placed under general anesthesia. . . .
During intubation, as part of the administration of anesthesia for Plaintiff's surgery, one of the tubes perforated Plaintiff's esophagus. Prior to the surgery and intubation, Plaintiff had no problems with her esophagus, nor did she complain of any bodily pain unassociated with her carpal tunnel. . . .
When Plaintiff awoke in recovery, she complained of excruciating pain in her chest and back. The Anesthesiologist was notified, and, unaware of the perforated esophagus, he ordered the administration of a drug for the chest pain and concluded that there was no issue with Plaintiff's heart. Plaintiff was discharged from the hospital later that afternoon. Plaintiff's neighbor picked her up and drove her home.
The neighbor returned the next day to check on Plaintiff. Plaintiff was unresponsive, so the neighbor took her to the emergency room of a nearby hospital. Upon diagnosis of the problem, Plaintiff was rushed into lifesaving surgery to repair her esophagus. Plaintiff's next memory was waking up in the intensive care unit after being in a drug-induced coma for several weeks. Plaintiff had additional surgeries and underwent intensive therapy to begin eating again and regain mobility. She testified that she continues to suffer from pain throughout the upper half of her body and from serious mental disorders as a result of the traumatic incident and the loss of independence because of her body's physical limitations following this incident.

         II. Plaintiff's Medical Malpractice Lawsuit

Plaintiff filed a medical negligence action against Defendants. The issues at trial encompassed personal liability and vicarious liability for Plaintiff's injuries, as well as the extent of the injuries and whether they amounted to "catastrophic injury" under section 766.118(1)(a). At the end of Plaintiff's case, all parties moved for directed verdict on various grounds. Primarily, Defendants contended that Plaintiff failed to meet the threshold for a determination of catastrophic injury. . . .
Ultimately, the trial court decided to submit [] two highly contested issues to the jury as questions on the verdict form. . . . With regard to catastrophic injury, the jury was asked to determine whether Plaintiff suffered a "permanent impairment constituted by either . . . [s]pinal cord injury involving severe paralysis of an arm, a leg, or the trunk . . . [or] [s]evere brain or closed-head injury evidenced by a severe episodic neurological disorder."
. . . [T]he jury determined that Plaintiff suffered catastrophic injury in the form of a "[s]evere brain or closed-head injury evidenced by a severe episodic neurological disorder" and awarded Plaintiff $4, 718, 011 in total damages. The noneconomic damage awards were $2 million for past pain and suffering and $2 million for future pain and suffering.
Multiple post-trial motions were filed, with Defendants primarily challenging the jury's finding of catastrophic injury by way of severe brain or closed-head injury. Defendants argued that there was no evidence in the record to support the jury's finding of such an injury. . . . All motions challenging the finding of catastrophic injury [] were denied. The court also rejected Plaintiff's challenge that the section 766.118 caps on noneconomic damages in medical negligence actions were unconstitutional.
The trial court issued a written final judgment as to damages. . . . The court [] limited the noneconomic damage awards by the caps provided in section 766.118, Florida Statutes (2011), after applying the increased cap for the finding of catastrophic injury, because the court found that competent substantial evidence existed in the record to support a finding of catastrophic injury under the statutory definition as determined by the jury. As such, the noneconomic damages award of $4 million was reduced by close to $2 million by the "[l]imitation on noneconomic damages for negligence of practitioners" under section 766.118(2) and "[l]imitation on noneconomic damages for negligence of nonpractitioner defendants" under section 766.118(3), Florida Statutes (2011). Furthermore, the noneconomic damages award was further reduced by about $1.3 million, as the Hospital's share of liability was capped at $100, 000 by virtue of the hospital's status as a sovereign entity. § 768.28, Fla. Stat. (2007).

Kalitan, 174 So.3d at 405-07.

         In its analysis with regard to Kalitan's constitutional challenge to the caps, the Fourth District observed that a majority of this Court in McCall determined that the cap on wrongful death noneconomic damages under section 766.118 violates the right to equal protection guaranteed by article I, section 2, of the Florida Constitution. The district court described the facts of McCall and highlighted relevant portions of the plurality and concurring in result opinions regarding the arbitrariness of the cap and the lack of a legitimate government interest justifying the cap. Although the Fourth District recognized that the decision in McCall was limited to a determination that the cap on noneconomic damages is unconstitutional in the context of wrongful death actions, it observed that section 766.118 applies to both wrongful death and personal injury actions. Thus, the district court applied this Court's rationale in McCall to the personal injury context, concluding that "McCall mandates a finding that the caps in section 766.118 personal injury cases are similarly unconstitutional." Id. at 405. Therefore, the Fourth District directed the trial court to reinstate the total damages award as found by the jury. This appeal followed.[2]

         STATUTORY PROVISION

         The issue before this Court concerns the caps on personal injury noneconomic damages in medical negligence actions provided in section 766.118, which states:

(2) LIMITATION ON NONECONOMIC DAMAGES FOR NEGLIGENCE OF PRACTITIONERS.-
(a) With respect to a cause of action for personal injury or wrongful death arising from medical negligence of practitioners, regardless of the number of such practitioner defendants, noneconomic damages shall not exceed $500, 000 per claimant. No practitioner shall be liable for more than $500, 000 in noneconomic damages, regardless of the number of claimants.
(b) Notwithstanding paragraph (a), if the negligence resulted in a permanent vegetative state or death, the total noneconomic damages recoverable from all practitioners, regardless of the number of claimants, under this paragraph shall not exceed $1 million. In cases that do not involve death or permanent vegetative state, the patient injured by medical negligence may recover noneconomic damages not to exceed $1 million if:
1. The trial court determines that a manifest injustice would occur unless increased noneconomic damages are awarded, based on a finding that because of the special circumstances of the case, the noneconomic harm sustained by the injured patient was particularly severe; and
2. The trier of fact determines that the defendant's negligence caused a catastrophic injury to the patient.
(c) The total noneconomic damages recoverable by all claimants from all practitioner defendants under this subsection shall not ...

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